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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pityriasis rubra pilaris &#40;PRP&#41; is an uncommon inflammatory disease&#44; traditionally considered as a reactive dermatosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;3</span></a> It appears in a bimodal age distribution in the first and fifth decades of life and equal frequency between sexes&#44; as follicular hyperkeratotic salmon-coloured papules and plaques&#46; Some patients develop erythroderma leaving islands of non-involved skin&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Diagnosis requires a good clinicopathological correlation&#46; Alternating orthokeratosis and parakeratosis known as &#8220;checkerboard pattern&#8221; is the main histopathological feature&#46; Treatment options include a variety of drugs such as topical corticosteroids&#44; oral retinoids&#44; immunosuppressors and biologic agents&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;4&#8211;6</span></a> PRP is believed to share cytokine environment with psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">There are no management guidelines and current scientific evidence is limited to case reports and case series&#46; Consequently&#44; management of PRP represents a challenge&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Objective</span><p id="par0020" class="elsevierStylePara elsevierViewall">To describe clinicopathological and demographic features of PRP patients and analyze treatment modalities&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A multicentre retrospective observational study was carried out in eight Spanish hospitals including patients with clinicopathological diagnosis of PRP&#44; treated during 20 years &#40;between January 2002 and February 2022&#41;&#46; Variables were collected by each centre in an anonymous database&#46; Paediatric sample was defined as patients under 16 years old&#46; We used body surface area &#40;BSA&#41; to evaluate treatment response and considered complete response as BSA &#60;3&#37;&#46; A descriptive statistical analysis was performed&#44; using the mean and standard deviation &#40;SD&#41; for quantitative variables and absolute and relative frequencies for qualitative variables&#46; The contrasts of hypotheses in the qualitative variables were carried out using the Chi-square test or Fisher&#39;s exact test and for quantitative variables using the Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#46; A <span class="elsevierStyleItalic">p</span>-value &#60;0&#46;05 was considered statistically significant&#46; All analyses were performed with the statistical software Stata&#174; &#40;StataCorp&#44; College Station&#44; Texas&#41; version 16 for Windows&#46; The study was conducted following the Declaration of Helsinki and was approved by the Medical Ethics Committee of the Hospital 12 de Octubre &#40;No&#58; 22&#47;233&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">Epidemiological&#44; clinical&#44; histopathological and therapeutic results can be found in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Epidemiology</span><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 65 patients were included&#46; At the time of enrolment&#44; eight children were an average of 7&#46;8 years old and four &#40;50&#37;&#41; were female&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Thirty-nine male patients represented 68&#37; of the adult sample and 40 of them &#40;70&#37;&#41; developed erythroderma&#44; but only one child&#46; Mean age was older in erythrodermic adults &#40;61 years&#41; when compared to non-erythrodermic adults &#40;51 years&#44; <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Triggers and comorbidities</span><p id="par0045" class="elsevierStylePara elsevierViewall">A possible trigger was reported by 13 &#40;20&#37;&#41; patients&#58; previous infection in seven &#40;12&#37;&#41; adults and two &#40;25&#37;&#41; children&#59; and drugs in four &#40;7&#37;&#41; adults&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Infections in children were all upper airway infections&#46; Among adult patients we did not collect specific microbiological agents data&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Four &#40;7&#37;&#41; of our adult patients had concomitant neoplasia and five &#40;9&#37;&#41; autoimmune comorbidities&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Clinical findings</span><p id="par0060" class="elsevierStylePara elsevierViewall">The most frequent clinical features were non-involved skin islands &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#44; 83&#37;&#41; and palmoplantar &#40;PP&#41; keratoderma &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&#44; 85&#37;&#41;&#44; which were also more frequent in erythrodermic patients &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; The difference was statistically significant for PP keratoderma &#40;<span class="elsevierStyleItalic">p</span>-value 0&#46;029&#41;&#46; However&#44; children presented only in two &#40;29&#37;&#41; and four &#40;50&#37;&#41; of the cases with non-involved skin islands and PP keratoderma respectively&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Forty-one &#40;63&#37;&#41; of patients reported pruritus&#44; but only two &#40;25&#37;&#41; children and 39 &#40;68&#37;&#41; of the adults &#40;<span class="elsevierStyleItalic">p</span>-value 0&#46;017&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Other clinical features are detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Histology</span><p id="par0075" class="elsevierStylePara elsevierViewall">Most frequent histological findings were alternating ortho- and parakeratosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#44; 67&#37;&#41; and irregular epidermic hyperplasia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#44; 59&#37;&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Treatment</span><p id="par0080" class="elsevierStylePara elsevierViewall">Mean treatment duration was 2&#46;4 months in children&#44; 8 months in non-erythrodermic adults and 21&#46;4 months in erythrodermic adults&#46; Time to BSA &#60;3&#37; was shorter and number of treatments lower in children and non-erythrodermic adults than their counterparts &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">All of the children were initially treated with topical corticosteroids&#46; Only one of them required acitretin&#46; One developed erythroderma and needed ustekinumab to control the disease&#46; Complete response &#40;CR&#41; was achieved in seven &#40;88&#37;&#41; of the children&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Non-erythrodermic adults &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#44; 30&#37;&#41; were successfully managed with topical therapy in nine &#40;60&#37;&#41; patients&#46; Six were treated with systemic agents &#40;acitretin in three and phototherapy in one patient&#41;&#46; Only five patients required a biologic agent&#46; CR was achieved in 13 &#40;76&#37;&#41; of non-erythrodermic adults&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">On the other hand&#44; 29 &#40;71&#37;&#41; erythrodermic patients were initially managed with systemic agents such as acitretin in twelve &#40;30&#37;&#41; of the cases or methotrexate in ten &#40;25&#37;&#41; of the patients&#44; phototherapy in seven &#40;18&#37;&#41; and one patient began with ustekinumab&#46; Last effective treatment included a variety of drugs &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; and complete response was achieved in 26 &#40;68&#37;&#41; of patients&#46; Biologic therapy was required at some point by 31 &#40;68&#37;&#41; of patients and ustekinumab was the most frequently used&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Limitations</span><p id="par0100" class="elsevierStylePara elsevierViewall">Our study has several limitations&#46; First&#44; our data was collected retrospectively with a relatively small sample size&#46; In addition&#44; there are no standardized diagnostic criteria of PRP or severity scales to asses treatment response&#46; Lastly&#44; the availability of new biologic therapies over the course of the last decade may have exerted some influence on therapeutic results of patients diagnosed in the latest years&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study presents detailed demographic&#44; clinicopathologic and treatment data in 65 patients diagnosed of PRP&#46; To the best of our knowledge&#44; this is the largest European case series of patients with PRP&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Our study demonstrated predominance in adult male patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#44; 68&#37;&#41;&#44; which differs from data on literature maintaining equal sex distribution&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;4</span></a> Bimodal distribution was consistent with literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;4</span></a> but strikingly adult patients presenting with erythroderma were on average 10 years older &#40;<span class="elsevierStyleItalic">p</span>-value &#60;0&#46;05&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Multiple case reports claim possible causality between malignancies or autoimmune disorders and PRP&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;7</span></a> However&#44; our adult patients showed a low frequency of autoimmune comorbidities &#40;9&#37;&#41; and malignancies &#40;6&#37;&#41;&#44; suggesting that their frequency may not differ from general population and screening procedures should be guided by history and physical examination&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Infectious and pharmacological agents have usually been described to trigger PRP&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2</span></a> Interestingly&#44; 25&#37; of our children reported an infectious trigger but in only 6&#37; of erythrodermic adults a culprit drug was demonstrated&#46; This supports the idea of PRP as a multifactorial disease&#44; in which environmental factors play a role but are not necessary for the development of the disease&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The most frequent histological feature was alternating ortho- and parakeratosis&#44; matching literature data&#46; However&#44; histology can be unspecific and often diagnosis is predominantly guided by characteristic clinical features&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;4</span></a> Sixty-six percent of our patients initiated lesions on the upper body&#44; which is consistent with the cephalocaudal progression classically described&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;4</span></a> Interestingly&#44; 94&#37; of our erythrodermic patients presented PP keratoderma &#40;<span class="elsevierStyleItalic">p</span>-value 0&#46;02&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Fouarge et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> already proposed PP keratoderma as a possible factor for resistance to an IL-23&#47;p19 antagonist&#46; In our opinion&#44; it may be a progression marker&#44; and could help identify patients at a higher risk of developing erythrodermic forms of PRP&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Seventy-five percent of the paediatric patients and 60&#37; of the non-erythrodermic adults controlled their disease with topical corticosteroids&#46; Good response to topical therapy was already described in paediatric PRP&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> but we assume it is extendible to adults with localized disease&#46; However&#44; most of erythrodermic patients &#40;68&#37;&#41; required biologic therapy as last and effective therapy line&#46; Among them&#44; 68&#37; achieved complete response but after an average of 6&#46;5 months of treatment&#46; They usually receive more lines of treatment &#40;mean 2&#46;7&#41; than patients with localized lesions and may benefit from a more invasive and early approach&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusion</span><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study reported that PRP may be more frequent in men and erythrodermic forms could appear in older patients&#46; There was no clear association with cancer or autoimmune diseases in our patients&#46; PP keratoderma may be a marker of progression to erythroderma&#46; Children and adults with localized disease in our sample usually respond to topical corticosteroids&#46; On the contrary&#44; erythrodermic patients received multiple therapy lines&#44; needed an average of 6&#46;5 months and a biologic agent to control their disease&#46; Further studies are required to investigate this challenging disease&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Patient&#39;s consent</span><p id="par0145" class="elsevierStylePara elsevierViewall">The patients in this manuscript have given written informed consent to publication of their case details&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Funding</span><p id="par0150" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0160" class="elsevierStylePara elsevierViewall">Dr Ruiz Genao has been reimbursed by Almirall&#44; Pfizer&#44; Janssen&#44; Amgen&#44; Abbvie&#44; Lilly&#44; UCB&#44; Novartis and Leo-Pharma for advisory services and conferences&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0165" class="elsevierStylePara elsevierViewall">L&#46; Puig has perceived consultancy&#47;speaker&#39;s honoraria from and&#47;or participated in clinical trials sponsored by Abbvie&#44; Almirall&#44; Amgen&#44; Biogen&#44; Boehringer Ingelheim&#44; Bristol Myers Squibb&#44; Janssen&#44; Leo-Pharma&#44; Lilly&#44; Novartis&#44; Pfizer&#44; Sandoz&#44; Sanofi&#44; and UCB&#46;</p></li></ul></p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PRP is a rare entity of unknown etiopathogenesis&#46; Lack of management guidelines makes it a challenge for clinicians&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Objective</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">To add our experience to increase evidence about PRP&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective&#44; descriptive and multicentric study of 65 patients with PRP&#44; being the largest European case series of patients with PRP&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">PRP was more frequent in male patients with an average age of 51 years&#44; but erythrodermic forms presented in older patients &#40;average age 61 years&#41;&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Six &#40;75&#37;&#41; paediatric patients and ten &#40;60&#37;&#41; non-erythrodermic adults controlled their disease with topical corticosteroids&#46; On the contrary&#44; 26 &#40;68&#37;&#41; erythrodermic patients required biologic therapy as last and effective therapy line requiring an average of 6&#46;5 months to achieve complete response&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Our study showed a statistical difference in terms of outcome and response to treatment between children or patients with limited disease and patients who develop erythroderma&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Autoimmune&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Malignancies&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Clinical findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Upper body initial lesions&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pruritus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">39 &#40;68&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;53&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nail involvement&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Erythroderma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non-involved skin islands&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PP keratoderma<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">53 &#40;82&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">49 &#40;86&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;93&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intertriginous involvement&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;32&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Histopathologic findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alternating ortho- and parakeratosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;67&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;68&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Irregular hyperplasia of the epidermis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peri-infundibular parakeratosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of biopsies</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of treatments</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;8 &#40;0&#46;7&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;7 &#40;1&#46;3&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">First line treatments</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acitretin&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ciclosporin&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Topical corticosteroids&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Isotretinoin&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Methotrexate&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>UVA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ustekinumab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Topical corticosteroids&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Methotrexate&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infliximab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ixekizumab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Secukinumab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ustekinumab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Brodalumab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46 &#40;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                          "autores" => array:4 [
                            0 => "D&#46; Wang"
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                          "etal" => false
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                            0 => "S&#46; Roenneberg"
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