Title: Acral Persistent Papular Mucinosis in Indian Patient: Rare Presentation with Review of Literature
Authors: Dr Amit Chauhan, Dr Mudita Gupta, Dr Anchana Gulati, Dr Pragya Gupta
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.14
Abstract
Acral persistent papular mucinosis is a rare subtype of localized lichen myxedematosus. Presenting as acrally located bilaterally symmetric, asymptomatic papules. These lesions are ivory to flesh-coloured, 2–5mm sized papules arranged on the dorsum of the hands and extensor aspects of distal forearms and are persistent. Thirty-five cases appear to fit the proposed diagnostic criteria till this date as reported in literature. We report a 60-year-old Indian man who presented with papules on the dorsum of his hands for last six years. Histopathology revealed circumscribed area in the upper and mid reticular dermis with splaying of collagen fibers caused by mucin deposits. Deposits stained positively with alcian blue at pH 2.5. The thyroid profile was normal.
Keywords: acral, persistent, mucinosis.
References
1. Rongioletti F, Rebora A. Cutaneous mucinoses: microscopic criteria for diagnosis. Am J Dermatopathol 2001; 23:257–67.
2. Harris JE, Purcell SM, Griffin TD.Acral persistent papular mucinosis.J Am Acad Dermatol 2004; 51: 982–8.
3. Rongioletti F, Rebora A. Updated classification of papular mucinosis, lichen myxedematosus, and scleromyxedema. J Am Acad Dermatol 2001;44:273-81.
4. Rongioletti F, Rebora A, Crovato F. Acral persistent papular mucinosis: a new entity. Arch Dermatol 1986;122:1237–9.
5. Luo D, Wu L, Liu J, Zhang H. Acral persistent papular mucinosis: a case report and literature review. J DtschDermatolGes 2011 9(5): 354-9.
6. Callaly E, Mulligan N, Powell F. Multiple painless papules on the wrists. Arch Dermatol 2007;143:791-6.
7. André Jorge F, Mimura Cortez T, Guadalini Mendes F, Esther Alencar Marques M, AmanteMiot H. Treatment of acral persistent papular mucinosis with electrocoagulation. J Cutan Med Surg 2011; 15(4): 227-9.
8. Rongioletti F, Zaccaria E, Cozzani E, Parodi A. Treatment of localized lichen myxedematosus of discrete type with tacrolimus ointment. J Am AcadDermatol 2008; 58: 530-2.
9. Garrido A, Helena, Najera et al. Acral Persistent Papular Mucinosis: is it an under-diagnosed disease? Dermatol. Online J 2014;20(3).
10. Dubreuilh W. Fibromesmiliaries folliculaires: Sclerodermie consecutive. Arch Dermatol Syphilol 1906;7:569-71.
11. Montgomery H, Underwood LJ. Lichen myxoedematosus; differentiation from cutaneous myxoedemas or mucoid states. J Invest Dermatol 1953;20:213-36.
12. Perry HO, Montgomery H, Stickney JM. Further observations on lichen myxoed-ematosus. Ann Intern Med 1960;53:955-69.
13. Madan V, Gangopadhyay M, Dawn G. Multiple asymptomatic papules on the legs. ClinExpDermatol 2007; 32:773–4.
14. Sebastian S, Zlotoff B, DeSantis E. 'Spreading bumps' on hands of a Native American. Clin Exp Dermatol 2008; 33:225–7.
15. Alkali AS,Wilson NJE, Leonard N. An asymptomatic eruption on the arms. ClinExpDermatol 2008; 33:675–6.
16. Sulit DJ, Harford R, O'Neill JT. Discrete papular form of lichen myxedematosus: a case report and review of the literature. Cutis 2005; 75:105– 12.
17. Menni S, Cavicchini S, Brezzi A, Gianotti R, Caputo R. Acral persistentpapular mucinosis in two sisters. ClinExpDermatol 1995; 20:431–3.
18. España A, Mosquera O, Idoate MA, Quintanilla E. Acral persistent papular mucinosis. Int J Dermatol 1993; 32:600–1.
19. Barba A, Maruccia A, D'Onghia FS. Persistent acralpapulous mucinosis. Ann DermatolVenereol 1996; 123: 256–8.
20. Crovato F, Nazzari G, Desirello G. Acral persistent papular mucinosis. J Am AcadDermatol 1990; 23:121–2.
21. Naeyaert JM, Kint A. Papular mucinosis. Dermatologica 1985; 171:508-9.
22. Rongioletti F. Lichen myxedematosus (papular mucinosis): new concepts and perspectives for an old disease. SeminCutan Med Surg 2006; 25:100–4.
23. André Jorge F, Mimura Cortez T, Guadalini Mendes F, Esther Alencar Marques M, Amante Miot H. Treatment of acral persistent papular mucinosis with electrocoagulation. J Cutan Med Surg 2011; 15(4):227-9.
24. Luo D, Wu L, Liu J, Zhang H. Acral persistent papular mucinosis: a case report and literature review. J Dtsch Dermatol Ges 2011 9(5): 354-9.
25. Borradori L, Aractingi S, Blanc F, Verola O, Dubertret L. Acral persistent papular mucinosis and IgA monoclonal gammopathy: report of a case. Dermatology 1992; 185:134–6.
26. Kwon OS, Moon SE, Kim JA, Cho KH. Lichen myxedematosus with rapid spont-aneous regression. Br J Dermatol1997; 136:295–6.
27. Colombo E, Ottinetti A, Silvestri T, Delrosso G, Dacorsi M. Acral persistent papular mucinosis. Eur J Dermatol1994; 4:124–6.