Cases and Research Letters
Zosteriform Connective Tissue Nevus: A New Case Report
Nevus de tejido conectivo con patrón zosteriforme. Aportación de un nuevo caso
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Castellanos-González, G. Petiti-Martín, C. Postigo, J.L. Rodriguez-Peralto" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Castellanos-González" "email" => array:1 [ 0 => "maria.castellanos.gonzalez@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" => "G." "apellidos" => "Petiti-Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Postigo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.L." "apellidos" => "Rodriguez-Peralto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología y Venereología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nevus de tejido conectivo con patrón zosteriforme. Aportación de un nuevo caso" ] ] "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" => 900 "Ancho" => 1750 "Tamanyo" => 186693 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infiltrated plaques with orange-peel skin. A, Deltoid area. B, Lower back.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Connective tissue nevus is a type of dermal hamartoma with a variable clinical presentation. This condition generally appears on the trunk or limbs as flesh-colored, yellowish, or brownish plaques with a marbled surface. Its most typical presentations include the orange-peel skin associated with tuberous sclerosis or cobblestone plaques. Connective tissue nevus is characterized by excess collagen or altered elastic fibers. Diagnosis is based on the correlation of clinical and pathological findings, and it is essential to identify variants that are potentially associated with extracutaneous manifestations. Zosteriform connective tissue nevus is an extremely rare variant, with only 5 cases reported to date.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 14-year-old girl with no past history of interest who came to our clinic with an indurated area on her right upper arm that first appeared when she was 6 months old. The lesion initially measured 1<span class="elsevierStyleHsp" style=""></span>cm and had gradually increased in size until it involved the whole deltoid area of that arm. The only concomitant symptom was difficulty raising her arms. Physical examination revealed a poorly defined indurated plaque measuring 7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>cm that extended from the deltoid area to the outer aspect of the right upper arm. The plaque was firm in consistency, had a cobblestone appearance, and was adherent to the deeper layers of the skin, with no alteration to adnexa or changes in the skin surface. She presented a second, similar plaque measuring 8<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm on her lower back (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">There were no significant findings on hematoxylin-eosin staining of a biopsy specimen of the lesion on the arm with the inclusion of subcutaneous tissue; however, staining for elastic fibers revealed a conserved epidermis and marked reduction and fragmentation of elastic fibers in the reticular dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). No accompanying inflammatory infiltrate was observed. The results of imaging tests (ultrasound, magnetic resonance, and Doppler ultrasound) were normal. No significant findings were detected in the complete blood count, biochemistry with liver and kidney function tests, or coagulation studies, and the results of an assessment in the cardiology department were unremarkable. After physiotherapy, physical examination revealed reduced infiltration, even though the lesions had extended to the elbow and onto the forearm.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The term connective tissue nevus was first mentioned by Lewandowsky in 1921, although it was not accepted until the review by Gutmann<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1926. Connective tissue nevus is considered a hamartoma of connective tissue (collagen or elastic tissue) that takes the form of tumor-like dermal lesions. Attempts have been made to classify the lesions according to histologic criteria, clinical criteria, or both. One of the most widely accepted classifications is that of Pierard and Lapiere, which divides connective tissue nevi into 2 types—reticular and adventitial—according their clinical and histopathological presentation. Zosteriform nevus is an unusual form of reticular connective tissue nevus that is diagnosed according to its clinical distribution. It was first described by Steiner<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in 1944. Since then, only 5 cases have been published (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>); 3 of those involved multiple lesions.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Once diagnosis is confirmed, it must be decided whether to extend the study and, if this is the case, the relevant additional tests must be selected. Several associations have been reported between familial connective tissue diseases and other diseases, principally affecting the heart.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Shagreen plaques, for example, are a major criterion for establishing a diagnosis of tuberous sclerosis. One case of connective tissue nevus associated with macrodactyly and hemihypertrophy has been reported.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> However, to date, we have been unable to find evidence of diseases associated with zosteriform connective tissue nevus. Therefore, if neither the history nor a detailed physical examination reveals findings indicative of associated diseases, it is not necessary to continue with the study. Observation alone is sufficient.</p><p id="par0030" class="elsevierStylePara elsevierViewall">As for clinical course, the lesions tend to be persistent and their prognosis depends on the presence of associated diseases. Treatment is only required in cases with major cosmetic repercussions.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, we present a new case of a rare condition that fits the description of connective tissue nevus. The lesions had a peculiar, zosteriform-type distribution. Our case is unusual in that it involved 2 areas: the deltoid area and the lower back. We wish to stress the importance of ruling out familial cases because of their frequent association with other diseases, which would necessitate a more meticulous workup.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Castellanos-González M, Petiti-Martín G, Postigo C, Rodriguez-Peralto JL. Nevus de tejido conectivo con patrón zosteriforme. Aportación de un nuevo caso. Actas Dermosifiliogr.2012;103:640-642.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 900 "Ancho" => 1750 "Tamanyo" => 186693 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infiltrated plaques with orange-peel skin. A, Deltoid area. B, Lower back.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 639 "Ancho" => 949 "Tamanyo" => 236698 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology with staining of elastic fibers (van Gieson, original magnification ×10). Note the significant reduction in elastic fibers.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Steiner<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Kozminsky et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Yeh et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Amjadi et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Brazelli et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 y \t\t\t\t\t\t\n \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 " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \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 " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Single plaque \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Several plaques \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Single plaque \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Forty nodules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Several plaques \t\t\t\t\t\t\n \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Site \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right thorax and back \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dermatomes C6<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>T1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right flank \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right lumbar region and upper part of right buttock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lumbosacral region and proximal right leg \t\t\t\t\t\t\n \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical course \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Since 7 years of age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Since birth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Since 6 years of age \t\t\t\t\t\t\n \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Concomitant symptoms and course \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isolated fibroma in right axilla \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \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 " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stable over time with no increase in size \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Progressive growth until 19 years of age. Some lesions coalesced to form plaques. Stable since then \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pathology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fragmented elastic fibers in the mid dermis. Trichrome staining did not reveal collagen abnormalities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fragmented elastic fibers in the mid dermis. No collagen abnormalities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excess collagen. Remaining connective tissue normal. No other significant findings \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thickening and sclerosis of the collagen fibers in the superficial, mid, and deep dermis, with nodular distribution accompanied by thinning and fragmentation of the elastic fibers \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182300.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara">These data are not specified in the corresponding article.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cases of Zosteriform Connective Tissue Nevus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Zur Frage der Bindegewebsnaevi" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 13 | 29 |
| 2024 October | 89 | 63 | 152 |
| 2024 September | 110 | 46 | 156 |
| 2024 August | 128 | 65 | 193 |
| 2024 July | 129 | 61 | 190 |
| 2024 June | 122 | 90 | 212 |
| 2024 May | 89 | 35 | 124 |
| 2024 April | 100 | 32 | 132 |
| 2024 March | 79 | 37 | 116 |
| 2024 February | 88 | 33 | 121 |
| 2024 January | 74 | 41 | 115 |
| 2023 December | 91 | 18 | 109 |
| 2023 November | 96 | 40 | 136 |
| 2023 October | 89 | 29 | 118 |
| 2023 September | 96 | 41 | 137 |
| 2023 August | 85 | 24 | 109 |
| 2023 July | 108 | 33 | 141 |
| 2023 June | 61 | 22 | 83 |
| 2023 May | 99 | 28 | 127 |
| 2023 April | 100 | 19 | 119 |
| 2023 March | 85 | 21 | 106 |
| 2023 February | 75 | 26 | 101 |
| 2023 January | 79 | 39 | 118 |
| 2022 December | 74 | 36 | 110 |
| 2022 November | 52 | 26 | 78 |
| 2022 October | 60 | 22 | 82 |
| 2022 September | 46 | 41 | 87 |
| 2022 August | 37 | 33 | 70 |
| 2022 July | 36 | 32 | 68 |
| 2022 June | 29 | 30 | 59 |
| 2022 May | 71 | 38 | 109 |
| 2022 April | 84 | 46 | 130 |
| 2022 March | 66 | 54 | 120 |
| 2022 February | 59 | 27 | 86 |
| 2022 January | 91 | 55 | 146 |
| 2021 December | 58 | 43 | 101 |
| 2021 November | 72 | 46 | 118 |
| 2021 October | 77 | 43 | 120 |
| 2021 September | 58 | 37 | 95 |
| 2021 August | 85 | 29 | 114 |
| 2021 July | 63 | 22 | 85 |
| 2021 June | 64 | 43 | 107 |
| 2021 May | 56 | 48 | 104 |
| 2021 April | 119 | 64 | 183 |
| 2021 March | 67 | 46 | 113 |
| 2021 February | 61 | 45 | 106 |
| 2021 January | 52 | 19 | 71 |
| 2020 December | 53 | 21 | 74 |
| 2020 November | 32 | 9 | 41 |
| 2020 October | 34 | 9 | 43 |
| 2020 September | 30 | 11 | 41 |
| 2020 August | 23 | 20 | 43 |
| 2020 July | 34 | 10 | 44 |
| 2020 June | 29 | 31 | 60 |
| 2020 May | 24 | 19 | 43 |
| 2020 April | 26 | 16 | 42 |
| 2020 March | 30 | 22 | 52 |
| 2020 February | 4 | 2 | 6 |
| 2020 January | 4 | 3 | 7 |
| 2019 December | 8 | 6 | 14 |
| 2019 November | 3 | 2 | 5 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 8 | 4 | 12 |
| 2019 August | 4 | 2 | 6 |
| 2019 July | 4 | 1 | 5 |
| 2019 June | 6 | 1 | 7 |
| 2019 May | 5 | 28 | 33 |
| 2019 April | 2 | 1 | 3 |
| 2019 March | 2 | 6 | 8 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 5 | 0 | 5 |
| 2018 September | 3 | 0 | 3 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 56 | 7 | 63 |
| 2018 January | 54 | 4 | 58 |
| 2017 December | 49 | 8 | 57 |
| 2017 November | 47 | 4 | 51 |
| 2017 October | 48 | 1 | 49 |
| 2017 September | 45 | 9 | 54 |
| 2017 August | 52 | 7 | 59 |
| 2017 July | 31 | 7 | 38 |
| 2017 June | 59 | 10 | 69 |
| 2017 May | 39 | 7 | 46 |
| 2017 April | 38 | 11 | 49 |
| 2017 March | 29 | 5 | 34 |
| 2017 February | 101 | 5 | 106 |
| 2017 January | 48 | 10 | 58 |
| 2016 December | 63 | 13 | 76 |
| 2016 November | 71 | 13 | 84 |
| 2016 October | 126 | 20 | 146 |
| 2016 September | 190 | 8 | 198 |
| 2016 August | 93 | 19 | 112 |
| 2016 July | 44 | 18 | 62 |
| 2016 June | 12 | 14 | 26 |
| 2016 May | 5 | 16 | 21 |
| 2016 April | 3 | 1 | 4 |
| 2016 March | 11 | 1 | 12 |
| 2016 February | 8 | 1 | 9 |
| 2016 January | 13 | 1 | 14 |
| 2015 December | 10 | 1 | 11 |
| 2015 November | 27 | 1 | 28 |
| 2015 October | 41 | 3 | 44 |
| 2015 September | 26 | 1 | 27 |
| 2015 August | 23 | 2 | 25 |
| 2015 July | 121 | 12 | 133 |
| 2015 June | 73 | 32 | 105 |
| 2015 May | 75 | 4 | 79 |
| 2015 April | 85 | 10 | 95 |
| 2015 March | 83 | 6 | 89 |
| 2015 February | 96 | 9 | 105 |
| 2015 January | 75 | 12 | 87 |
| 2014 December | 80 | 10 | 90 |
| 2014 November | 66 | 7 | 73 |
| 2014 October | 96 | 14 | 110 |
| 2014 September | 78 | 17 | 95 |
| 2014 August | 51 | 6 | 57 |
| 2014 July | 34 | 7 | 41 |
| 2014 June | 49 | 7 | 56 |
| 2014 May | 69 | 10 | 79 |
| 2014 April | 42 | 5 | 47 |
| 2014 March | 59 | 11 | 70 |
| 2014 February | 42 | 6 | 48 |
| 2014 January | 60 | 11 | 71 |
| 2013 December | 45 | 3 | 48 |
| 2013 November | 46 | 17 | 63 |
| 2013 October | 47 | 7 | 54 |
| 2013 September | 32 | 7 | 39 |
| 2013 August | 30 | 15 | 45 |
| 2013 July | 17 | 9 | 26 |
| 2013 June | 11 | 16 | 27 |
| 2013 May | 11 | 9 | 20 |
| 2013 April | 12 | 10 | 22 |
| 2013 March | 18 | 8 | 26 |
| 2013 February | 34 | 5 | 39 |
| 2013 January | 55 | 9 | 64 |
| 2012 December | 25 | 11 | 36 |
| 2012 November | 1 | 5 | 6 |
| 2012 October | 0 | 5 | 5 |
| 2012 September | 0 | 1 | 1 |
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