Cases for Diagnosis
Eczematous Dermatitis Presenting as a Clear Cell Acanthoma–Like Lesion on the Nipple and Areola
Dermatitis eccematosa del pezón/aréola con patrón de acantoma de células claras o pseudoacantoma de células claras
Read
2307
Timeswas read the article
593
Total PDF
1714
Total HTML
Share statistics
array:24 [ "pii" => "S000173102400022X" "issn" => "00017310" "doi" => "10.1016/j.ad.2024.01.007" "estado" => "S300" "fechaPublicacion" => "2024-03-01" "aid" => "3786" "copyright" => "AEDV" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2024;115:T299-T300" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S000173102200905X" "issn" => "00017310" "doi" => "10.1016/j.ad.2022.07.023" "estado" => "S300" "fechaPublicacion" => "2024-03-01" "aid" => "3270" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2024;115:301-2" "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">CASOS PARA EL DIAGNÓSTICO</span>" "titulo" => "Un paciente con una policondritis recidivante y nódulos cutáneos en seguimiento en hematología por un síndrome mielodisplásico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "301" "paginaFinal" => "302" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Patient With Relapsing Polychondritis and Cutaneous Nodules Being Followed by the Hematology Department for a Myelodysplastic Syndrome" ] ] "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" => 526 "Ancho" => 700 "Tamanyo" => 158791 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Biopsia de lesión nodular en pierna, objetivándose vasculitis de vaso de mediano calibre y oclusión vascular con recanalización. Hematoxilina-eosina, ×100.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Couselo-Rodríguez, M.Á. Viejo-Rodríguez, L. Carballeira-Seoane, C. Álvarez-Álvarez, E. Cervates-Pérez, M.Á. García-González, Á. Flórez" "autores" => array:7 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Couselo-Rodríguez" ] 1 => array:2 [ "nombre" => "M.Á." "apellidos" => "Viejo-Rodríguez" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Carballeira-Seoane" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Álvarez-Álvarez" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Cervates-Pérez" ] 5 => array:2 [ "nombre" => "M.Á." "apellidos" => "García-González" ] 6 => array:2 [ "nombre" => "Á." "apellidos" => "Flórez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173102200905X?idApp=UINPBA000044" "url" => "/00017310/0000011500000003/v1_202403090527/S000173102200905X/v1_202403090527/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S000173102300220X" "issn" => "00017310" "doi" => "10.1016/j.ad.2022.06.028" "estado" => "S300" "fechaPublicacion" => "2024-03-01" "aid" => "3430" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2024;115:299-300" "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">Casos para el diagnóstico</span>" "titulo" => "Dermatitis eccematosa del pezón/aréola con patrón de acantoma de células claras o pseudoacantoma de células claras" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "299" "paginaFinal" => "300" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Eczematous Dermatitis Presenting as a Clear Cell Acanthoma–Like Lesion on the Nipple and Areola" ] ] "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" => 408 "Ancho" => 1005 "Tamanyo" => 154848 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tinción hematoxilina-eosina. Aumentos 10× y 20×.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Ballesteros Redondo, L. Fernández Domper, C. Monteagudo Castro" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Ballesteros Redondo" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Fernández Domper" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Monteagudo Castro" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173102300220X?idApp=UINPBA000044" "url" => "/00017310/0000011500000003/v1_202403090527/S000173102300220X/v1_202403090527/es/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S000173102300220X" "issn" => "00017310" "doi" => "10.1016/j.ad.2022.06.028" "estado" => "S300" "fechaPublicacion" => "2024-03-01" "aid" => "3430" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2024;115:299-300" "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">Casos para el diagnóstico</span>" "titulo" => "Dermatitis eccematosa del pezón/aréola con patrón de acantoma de células claras o pseudoacantoma de células claras" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "299" "paginaFinal" => "300" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Eczematous Dermatitis Presenting as a Clear Cell Acanthoma–Like Lesion on the Nipple and Areola" ] ] "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" => 408 "Ancho" => 1005 "Tamanyo" => 154848 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tinción hematoxilina-eosina. Aumentos 10× y 20×.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Ballesteros Redondo, L. Fernández Domper, C. Monteagudo Castro" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Ballesteros Redondo" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Fernández Domper" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Monteagudo Castro" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173102300220X?idApp=UINPBA000044" "url" => "/00017310/0000011500000003/v1_202403090527/S000173102300220X/v1_202403090527/es/main.assets" ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cases for Diagnosis</span>" "titulo" => " Eczematous Dermatitis Presenting as a Clear Cell Acanthoma–Like Lesion on the Nipple and Areola" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T299" "paginaFinal" => "T300" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Ballesteros Redondo, L. Fernández Domper, C. Monteagudo Castro" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Ballesteros Redondo" "email" => array:1 [ 0 => "manuelballesteros94@gmail.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" => "L." "apellidos" => "Fernández Domper" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Monteagudo Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitariode Valencia, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital ClínicoUniversitario de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis eccematosa del pezón/aréola con patrón de acantoma de células claras o pseudoacantoma de células claras" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 678 "Ancho" => 1684 "Tamanyo" => 321420 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin staining. 10x and 20x magnifications.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical history</span><p id="par0005" class="elsevierStylePara elsevierViewall">These are the case reports of 2 women, aged 32 and 45, with a past medical history of atopic dermatitis and no other significant medical history who presented with nearly identical clinical signs. Both reported the appearance of a pruritic lesion on their breast apparently unrelated to any specific trigger. They were not breastfeeding and denied any family history of breast cancer.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical examination</span><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patient #1.</span> The lesion had appeared almost a month ago. The physical examination revealed the presence of an erythematous, scaly, verrucous-looking plaque on the right nipple, with minimal exudation and no signs of scratching (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patient #2.</span> Patient with phototype V, with a brownish, scaly plaque affecting the left breast areola-nipple complex, with poorly demarcated borders and no palpable induration (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Neither one of the 2 patients had underlying breast masses or axillary lymphadenopathy.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0025" class="elsevierStylePara elsevierViewall">The histopathological examination of a punch biopsy identified the presence of psoriasiform epidermal hyperplasia, along with pale cytoplasm keratinocytes and eosinophilic exocytosis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Supplementary tests</span><p id="par0030" class="elsevierStylePara elsevierViewall">Both patients had normal previous ultrasounds and/or mammograms.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">What is the diagnosis?</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Eczematous nipple dermatitis with clear cell acanthoma dermoscopy pattern, or pseudoxanthoma of clear cells.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Evolution and treatment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Since these were eczemas with special histopathological features, they were treated with medium-potency topical corticosteroids and antibiotics, leading to complete resolution 1 month after starting treatment. The patients remain lesion-free to this date, using moisturizing creams for atopic skin as maintenance therapy. However, 1 of them continues to experience mild dermatitis flare-ups at other sites.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">Clear cell acanthoma (CCA) was first described by Degos et al. in 1962 as a benign epidermal tumor. It often occurs on the lower limbs in middle-aged individuals and presents as a solitary reddish papule or nodule with vascular dots inside (referred to as “pearl-necklace pattern” in dermatoscopy). However, atypical, multiple, and even spontaneous regression sites and clinical forms have been reported. Along with its histopathological features, this has led to suggesting that CCA could be a reactive hyperplasia to chronic inflammation.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The histopathology of CCA is very typical with well-demarcated regions of psoriasiform epidermal hyperplasia, along with pale cytoplasm keratinocytes and neutrophilic exocytosis. The periodic acid-Schiff (PAS) staining often confirms the presence of glycogen in the pale cells.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">CCA of the areola-nipple complex has been reported in the medical literature in less than 20 patients, mostly young Asian women, although it can also affect men as well.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Except for 1 case that was probably a true CCA, these lesions often present as pruritic eczematous and unilateral plaques, or else bilateral in up to 50% of the cases.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The lesions appear on the mammary areola but can also compromise the nipple. Therefore, differential diagnosis must include Paget's disease, erosive adenomatosis of the nipple, or nipple and areola hyperkeratosis, among other causes of persistent nipple eczema. Unlike traditional CCA, the inflammatory infiltrate and exocytosis from eosinophils are both significant findings at histopathological level.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Given its association with atopic dermatitis in 25% to 43% of the cases, the presence of eosinophils at histopathological level, and healing with topical corticosteroids, it should be considered a non-neoplastic inflammatory disease and called eczematous nipple/areola dermatitis with a CCA pattern.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">We believe it is important to raise awareness of this condition to avoid aggressive therapies such as surgical procedures in these patients due to the location and future functional, aesthetic, and sexual implications.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical history" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Supplementary tests" ] 4 => array:3 [ "identificador" => "sec0025" "titulo" => "What is the diagnosis?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Diagnosis" ] ] ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Evolution and treatment" ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 641 "Ancho" => 1676 "Tamanyo" => 135664 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 678 "Ancho" => 1684 "Tamanyo" => 321420 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin staining. 10x and 20x magnifications.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clear cellacanthoma (CCA)-like lesions of the nipple/areola: A clini-copathological study of 12 cases supporting a nonneoplasticeczematous disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.L. Kuo" 1 => "C.S. Lo" 2 => "L.Y. Lee" 3 => "C.H. Yang" 4 => "T.T. Kuo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2016.07.032" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2019" "volumen" => "80" "paginaInicial" => "749" "paginaFinal" => "755" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30558902" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clear Cell Acanthoma of the Areolaand Nipple" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Hidalgo-García" 1 => "P. Gonzálvo" 2 => "S. Mallo-García" 3 => "C. Fernández-Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2016.04.008" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2016" "volumen" => "107" "paginaInicial" => "793" "paginaFinal" => "795" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27206609" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clear cell acanthoma of the areola andnipple: clinical, histopathological, and immunohistochemicalfeatures of two Brazilian cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.R. Veiga" 1 => "R.S. Barros" 2 => "J.E. Santos" 3 => "J.M. Abreu Junior" 4 => "J. BittencourtMde" 5 => "M.F. Miranda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0365-05962013000100010" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol." "fecha" => "2013" "volumen" => "88" "paginaInicial" => "84" "paginaFinal" => "89" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23539008" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral clear cell acanthoma ofthe areola and nipple: good response to topical corti-costeroids" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. González-Guerra" 1 => "J.R. Rodriguez" 2 => "A.F. Casado" 3 => "A.C. Taboada" 4 => "J.A.C. Toro" 5 => "E.L. Bran" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.20175683" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol." "fecha" => "2017" "volumen" => "92" "numero" => "5 Suppl 1" "paginaInicial" => "27" "paginaFinal" => "29" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clear Cell Acanthomaon the Areola" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.J. Borda" 1 => "J.S. Mervis" 2 => "P. Romanelli" 3 => "H. Lev-Tov" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Dermatol Online J." "fecha" => "2018" "volumen" => "24" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011500000003/v1_202403090527/S000173102400022X/v1_202403090527/en/main.assets" "Apartado" => array:4 [ "identificador" => "6161" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Casos para el diagnóstico" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011500000003/v1_202403090527/S000173102400022X/v1_202403090527/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173102400022X?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 19 | 14 | 33 |
| 2024 October | 169 | 76 | 245 |
| 2024 September | 190 | 49 | 239 |
| 2024 August | 237 | 94 | 331 |
| 2024 July | 162 | 36 | 198 |
| 2024 June | 123 | 49 | 172 |
| 2024 May | 169 | 62 | 231 |
| 2024 April | 113 | 47 | 160 |
| 2024 March | 316 | 43 | 359 |
| 2024 February | 110 | 50 | 160 |
| 2024 January | 106 | 73 | 179 |
