Case and Research Letter
Generalized Papular Granuloma Annulare Presenting With Pseudoxanthoma Elasticum-Like Lesions
Granuloma anular papular generalizado: una presentación similar a pseudoxantoma elástico
R. Calado
, C. Figueiredo, J.C. Cardoso, H.S. Oliveira
Corresponding author
Coimbra Hospital University Centre, Department of Dermato-venereology, Coimbra, Portugal
Read
2944
Timeswas read the article
949
Total PDF
1995
Total HTML
Share statistics
array:24 [ "pii" => "S0001731023000765" "issn" => "00017310" "doi" => "10.1016/j.ad.2022.05.041" "estado" => "S300" "fechaPublicacion" => "2023-10-01" "aid" => "3384" "copyright" => "AEDV" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2023;114:839-40" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0001731023006257" "issn" => "00017310" "doi" => "10.1016/j.ad.2023.07.017" "estado" => "S300" "fechaPublicacion" => "2023-10-01" "aid" => "3616" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2023;114:T839-T840" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICO-CLÍNICA</span>" "titulo" => " Granuloma anular papular generalizado: una presentación similar a pseudoxantoma elástico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T839" "paginaFinal" => "T840" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Generalized Papular Granuloma Annulare Presenting With Pseudoxanthoma Elasticum-Like Lesions" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 287 "Ancho" => 1005 "Tamanyo" => 112633 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">a) Infiltrado dérmico intersticial superficial y profundo con histiocitos e infiltrado linfocitario perivascular (hematoxilina y eosina 40×). b) Depósitos de mucina observados con tinción de azul alcián (hematoxilina y eosina 60×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Calado, C. Figueiredo, J.C. Cardoso, H.S. Oliveira" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Calado" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Figueiredo" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Cardoso" ] 3 => array:2 [ "nombre" => "H.S." "apellidos" => "Oliveira" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023006257?idApp=UINPBA000044" "url" => "/00017310/0000011400000009/v1_202310020456/S0001731023006257/v1_202310020456/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0001731023005896" "issn" => "00017310" "doi" => "10.1016/j.ad.2023.07.011" "estado" => "S300" "fechaPublicacion" => "2023-10-01" "aid" => "3595" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2023;114:T837-T838" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => " Primary Erythromelalgia: A Case Report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T837" "paginaFinal" => "T838" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eritromelalgia primaria: a propósito de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 538 "Ancho" => 805 "Tamanyo" => 69402 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythema with fine palmar scaling.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Ballano Ruiz, B. Aldea Manrique, A. Diago Irache, Y. Gilaberte Calzada" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Ballano Ruiz" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Aldea Manrique" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Diago Irache" ] 3 => array:2 [ "nombre" => "Y." "apellidos" => "Gilaberte Calzada" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023005896?idApp=UINPBA000044" "url" => "/00017310/0000011400000009/v1_202310020456/S0001731023005896/v1_202310020456/en/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S0001731023006257" "issn" => "00017310" "doi" => "10.1016/j.ad.2023.07.017" "estado" => "S300" "fechaPublicacion" => "2023-10-01" "aid" => "3616" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2023;114:T839-T840" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICO-CLÍNICA</span>" "titulo" => " Granuloma anular papular generalizado: una presentación similar a pseudoxantoma elástico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T839" "paginaFinal" => "T840" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Generalized Papular Granuloma Annulare Presenting With Pseudoxanthoma Elasticum-Like Lesions" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 287 "Ancho" => 1005 "Tamanyo" => 112633 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">a) Infiltrado dérmico intersticial superficial y profundo con histiocitos e infiltrado linfocitario perivascular (hematoxilina y eosina 40×). b) Depósitos de mucina observados con tinción de azul alcián (hematoxilina y eosina 60×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Calado, C. Figueiredo, J.C. Cardoso, H.S. Oliveira" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Calado" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Figueiredo" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Cardoso" ] 3 => array:2 [ "nombre" => "H.S." "apellidos" => "Oliveira" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023006257?idApp=UINPBA000044" "url" => "/00017310/0000011400000009/v1_202310020456/S0001731023006257/v1_202310020456/es/main.assets" ] ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Generalized Papular Granuloma Annulare Presenting With Pseudoxanthoma Elasticum-Like Lesions" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "839" "paginaFinal" => "840" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Calado, C. Figueiredo, J.C. Cardoso, H.S. Oliveira" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Calado" "email" => array:1 [ 0 => "a.rebecalado@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Figueiredo" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Cardoso" ] 3 => array:2 [ "nombre" => "H.S." "apellidos" => "Oliveira" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Coimbra Hospital University Centre, Department of Dermato-venereology, Coimbra, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Granuloma anular papular generalizado: una presentación similar a pseudoxantoma elástico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 287 "Ancho" => 1005 "Tamanyo" => 110727 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Interstitial dermal infiltrate of histiocytes in superficial and deep reticular dermis and perivascular lymphocytic infiltrate (hematoxylin and eosin 40×). (b) Deposition of mucin yielded by Alcian blue stain (hematoxylin and eosin 60×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 48-year-old female presented with a 5-year history of a mildly pruritic cutaneous eruption starting on the neck and upper chest, gradually spreading to the axilla, arms, and trunk. The lesions had failed to respond to moderate potency topical steroids and improved with short courses of oral steroids, with frequent relapses.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient had celiac disease and her family history was irrelevant. She denied any systemic symptoms and she didn’t take any regular medication.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On clinical examination she had numerous widespread, monomorphic skin-colored papules, with a “cobblestone” appearance, symmetrically distributed over the neck, upper trunk, proximal arms, and axilla (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a, b). The clinical presentation suggested the diagnosis of pseudoxanthoma elasticum, PXE-like papillary dermal elastolysis (PXE-PDE) or middermal elastolysis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The skin biopsy revealed interstitial dermal infiltration with histiocytes and perivascular lymphocytic infiltrate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>a). Alcian blue stain detected deposition of mucin, and Verhoeff stain confirmed regular distribution of dermal elastic fibers, which favored the diagnosis of interstitial granuloma annulare (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2b and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Laboratory tests, including complete blood cell count, blood chemistry, fasting lipid profile, thyroid profile, antinuclear antibodies, infectious serologies (anti-HCV, HBVs antigen, HIV) and serum protein electrophoresis were unremarkable.</p><p id="par0030" class="elsevierStylePara elsevierViewall">As phototherapy was unavailable because of the COVID-19 pandemic, the patient was started on dapsone 50<span class="elsevierStyleHsp" style=""></span>mg/day, which was discontinued because of gastrointestinal intolerance. When available, the patient started on PUVA, using standard dose oral 8-methoxypsoralen, three times a week, at an initial irradiance of 2.5<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>, increasing 0.5<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span> per session, as tolerated, with a final dose of 12<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">There was a significant response after 55 treatments.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Granuloma annulare (GA) is a non-infectious granulomatous dermatosis, classically presenting as annular arranged skin-colored to erythematous papules, involving the dorsal hands and/or feet. Several morphological forms have been described including generalized, subcutaneous and perforating cases. Generalized variant (GGA) presents heterogeneously, with annular plaques seen in only 8–15% of cases. The papular morphology described in our report is though uncommon and presented a diagnostic challenge.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The resemblance with pseudoxanthoma-elasticum and middermal elastolysis has not been described before, though similarities in the pathogenesis of granuloma annulare and middermal elastolysis suggest both entities may be related.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> PXE-PDE, an underrecognized entity, can present with a similar clinical picture, but it typically has a bandlike loss of elastic fibers in the papillary dermis, which was not found in our case (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Several other differential diagnosis such as interstitial granulomatous dermatitis, white fibrous papulosis of the neck, papular mucinosis and reticulated erythematous mucinosis could also be considered, though these can be easily ruled out based on clinic and histologic features.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The diagnosis of GGA requires clinicopathological correlation. The skin biopsy shows palisading granulomas, lymphohistiocytic infiltrate and mucin deposition – a key histological feature to distinguish GA from other granulomatous diseases.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Of note, in interstitial GA, histopathologic findings are subtle and there is no necrobiosis.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Several systemic associations have been proposed but they lack scientific evidence and the etiology remains unknown. Insect bites, trauma, herpes zoster, other viral infections, the administration of the bacille Calmette-Guérin (BCG) vaccination and drugs such as biologic therapies have been reported as potential triggering factors.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Further workup for underlying diseases such as diabetes, dyslipidemia, malignancy, thyroid disease and systemic infection is advised in patients with generalized or atypical forms of the disease, as in the reported case.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Most of the reported treatments in the literature are based on case reports and small retrospective studies, and the outcomes are usually unsatisfactory.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,8</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The most popular treatment modalities are topical and systemic steroids, isotretinoin, dapsone, biological agents, surgery, laser treatment, and phototherapy.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Despite prednisone being effective in many cases, GGA follows a chronic course, requiring a safer long-term therapy.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Methotrexate is the immunosuppressant most used by dermatologists, other than prednisone.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Phototherapy, especially PUVA, is the best studied modality of treatment in GGA, with recent analyses advising it as first line treatment, when available.</p><p id="par0085" class="elsevierStylePara elsevierViewall">A retrospective study of 33 patients with GGA treated with PUVA showed significant improvement in 66% of the patients. However most of these patients experienced recurrences within 2 years.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Another recent retrospective study found a beneficial effect in the majority of patients receiving UVA1 and PUVA.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The mechanism of action of PUVA in GA is possibly related to the inhibition of T lymphocytes and accessory effects on macrophages and metalloproteinase induction.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Narrow-band ultraviolet B (NB-UVB) therapy is another viable phototherapy alternative when PUVA is not possible.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">We report a new distinct clinical picture of GGA, which can be misdiagnosed as pseudoxanthoma elasticum and requires accurate clinicopathological correlation to achieve the diagnosis. Additionally, we demonstrate PUVA as an efficient therapy for this challenging-to-treat condition.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 500 "Ancho" => 755 "Tamanyo" => 51810 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a, b) Thin grouped papules with a “cobblestone” appearance over the lateral neck and axilla, resembling pseudoxanthoma-elasticum.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 287 "Ancho" => 1005 "Tamanyo" => 110727 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Interstitial dermal infiltrate of histiocytes in superficial and deep reticular dermis and perivascular lymphocytic infiltrate (hematoxylin and eosin 40×). (b) Deposition of mucin yielded by Alcian blue stain (hematoxylin and eosin 60×).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 427 "Ancho" => 755 "Tamanyo" => 101302 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Verhoeff-van Gieson stain shows conserved oxytalan elastic fibers in the papillary and reticular dermis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiology, diagnosis, and therapeutic management of granuloma annulare: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.A. Thornsberry" 1 => "J.C. English" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40257-013-0029-5" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "279" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23696233" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A focused review of therapeutic options" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Wang" 1 => "A. Khachemoune" 2 => "Granuloma Annulare:" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40257-017-0334-5" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2018" "volumen" => "19" "paginaInicial" => "333" "paginaFinal" => "344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29230666" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Generalised granuloma annulare successfully treated with PUVA" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Setterfield" 1 => "S.C. Huilgol" 2 => "M.M. Black" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-2230.1999.00532.x" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "1999" "volumen" => "24" "paginaInicial" => "458" "paginaFinal" => "460" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10606948" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Middermal elastolysis—a possible end stage of granuloma annulare" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.J.v.D. Lieke" 1 => "A.H. Myrurgia" 2 => "L. Frank S van" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2020.0552" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2020" "volumen" => "156" "paginaInicial" => "1024" "paginaFinal" => "1026" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32401268" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudoxanthoma elasticum-like papillary dermal elastolysis: a mimicker of genetic pseudoxanthoma elasticum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Atzori" 1 => "C. Ferreli" 2 => "L. Pilloni" 3 => "F. Rongioletti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2020.10.018" "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2021" "volumen" => "39" "paginaInicial" => "206" "paginaFinal" => "210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34272011" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disseminated eruptive interstitial granuloma annulare mimicking lichen nitidus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Tanyildizi" 1 => "S. Akarsu" 2 => "T. Ilknur" 3 => "B. Lebe" 4 => "E. Fetil" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1684/ejd.2011.1417" "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2011" "volumen" => "21" "paginaInicial" => "644" "paginaFinal" => "645" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21697057" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of generalized granuloma annulare – a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Lukács" 1 => "S. Schliemann" 2 => "P. Elsner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.12976" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2015" "volumen" => "29" "paginaInicial" => "1467" "paginaFinal" => "1480" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25651003" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful treatment of disseminated granuloma annulare with narrowband UV-B phototherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Solano-López" 1 => "M.J. Concha-Garzón" 2 => "D. De Argila" 3 => "E. Daudén" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.adengl.2015.01.014" "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2015" "volumen" => "106" "paginaInicial" => "240" "paginaFinal" => "241" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoralen and ultraviolet A in the treatment of granuloma annulare" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Browne" 1 => "D. Turner" 2 => "V. Goulden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Photodermatol Photoimmunol Photomed" "fecha" => "2011" "volumen" => "27" "paginaInicial" => "81" "paginaFinal" => "84" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A monocentric, retrospective analysis of 61 patients with generalized granuloma annulare" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.M. Nordmann" 1 => "J.R. Kim" 2 => "R. Dummer" 3 => "F. Anzengruber" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatology" "fecha" => "2020" "volumen" => "236" "paginaInicial" => "369" "paginaFinal" => "374" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011400000009/v1_202310020456/S0001731023000765/v1_202310020456/en/main.assets" "Apartado" => array:4 [ "identificador" => "6160" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científico-clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011400000009/v1_202310020456/S0001731023000765/v1_202310020456/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023000765?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 10 | 17 |
| 2024 October | 102 | 58 | 160 |
| 2024 September | 122 | 40 | 162 |
| 2024 August | 164 | 74 | 238 |
| 2024 July | 118 | 63 | 181 |
| 2024 June | 141 | 50 | 191 |
| 2024 May | 104 | 41 | 145 |
| 2024 April | 89 | 30 | 119 |
| 2024 March | 83 | 49 | 132 |
| 2024 February | 70 | 37 | 107 |
| 2024 January | 110 | 43 | 153 |
| 2023 December | 80 | 29 | 109 |
| 2023 November | 145 | 49 | 194 |
| 2023 October | 216 | 69 | 285 |
| 2023 September | 86 | 53 | 139 |
| 2023 August | 47 | 38 | 85 |
| 2023 July | 98 | 70 | 168 |
| 2023 June | 67 | 25 | 92 |
| 2023 May | 61 | 25 | 86 |
| 2023 April | 33 | 29 | 62 |
| 2023 March | 47 | 46 | 93 |
| 2023 February | 5 | 21 | 26 |
Show all
