Cases and Research Letters
Exacerbation of Atopic Dermatitis in a Patient Treated With Infliximab
Exacerbación de dermatitis atópica en paciente tratado con infliximab
R. Ruiz-Villaverde
, M. Galán-Gutierrez
Corresponding author
Unidad de Dermatología, Complejo Hospitalario de Jaén, Jaén, Spain
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Ruiz-Villaverde, M. Galán-Gutierrez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" "email" => array:1 [ 0 => "ismenios@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Galán-Gutierrez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Dermatología, Complejo Hospitalario de Jaén, Jaén, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Exacerbación de dermatitis atópica en paciente tratado con infliximab" ] ] "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" => 974 "Ancho" => 1301 "Tamanyo" => 182262 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical improvement of our patient after 3 weeks of treatment with oral corticosteroids.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Biologic agents are now being used to treat chronic inflammatory diseases, mainly those of rheumatic, dermatologic, or gastrointestinal origin. This development has led to a reassessment of the diagnosis and therapeutic management of their associated adverse effects, which can include relapses of certain pre-existing diseases that a patient may have; although these relapses have been successfully treated in some cases, they have been difficult to control in others.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We present the case of a patient with infliximab-treated ulcerative colitis who developed a relapse of atopic dermatitis, and we review the cases reported in the literature.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 30-year-old man with a past history of ulcerative colitis on treatment with infliximab; the disease had been refractory to treatment with mesalazine and azathioprine. After the fifth infusion he developed widespread, intensely pruritic eczema that did not respond to topical corticosteroids or oral antihistamines.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient had a history of atopic dermatitis (AD) since childhood, but denied rhinitis or extrinsic asthma. The AD lesions had always developed in flexures (cubital and popliteal fossae) and had responded to corticosteroids and topical calcineurin inhibitors, without requiring systemic treatment or phototherapy.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On physical examination, erythema and fine desquamation were observed on the face, trunk, and in the limb flexures; almost 50% of the body surface area was affected (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were no alterations of vital signs and respiratory function was not affected.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Additional tests did not reveal eosinophilia or elevation of immunoglobulin (Ig) E or acute phase reactants (C-reactive protein, erythrocyte sedimentation rate). Moderate spongiosis and a predominantly lymphocytic perivascular infiltrate were observed on histology. The absence of necrotic keratinocytes, the minimal damage to the basal layer, and the deep lymphocytic infiltrate with no eosinophils, together with the clinical manifestations, were more suggestive of a relapse of his AD than of a toxic dermatitis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">As a precaution it was decided to interrupt treatment with infliximab and start prednisone 0.5<span class="elsevierStyleHsp" style=""></span>mg/kg/d in a slowly tapering regimen. Control of the skin condition was achieved in 3 weeks (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The etiology and pathogenesis of AD is characterized by an acute phase with an inflammatory pattern involving type 2 helper T (T<span class="elsevierStyleInf">H</span>2) cells (often with elevated IgE levels and eosinophil counts), and a chronic phase with a T<span class="elsevierStyleInf">H</span>1 inflammatory pattern. It is therefore to be expected that the anti-tumor necrosis factor (TNF) agents used in psoriasis would improve the chronic forms of AD but that there would be no clear response in the acute phase.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In the chronic phase of AD there is elevation of serum TNF-α, which is released initially by mast cells and subsequently by the T<span class="elsevierStyleInf">H</span> lymphocytes and keratinocytes. The release of the cytokine further stimulates the inflammatory cascade, leading to higher levels of interleukins 1, 6, and 8, intercellular adhesion molecule 1, and vascular cell adhesion molecule. The clinical and pathological progression of a T<span class="elsevierStyleInf">H</span>2 inflammatory pattern to a T<span class="elsevierStyleInf">H</span>1 pattern could explain the successful response to therapy in some series of atopic patients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, it would appear likely that additional, unidentified etiological and pathogenic factors are involved as, in the majority of reported cases, the response is limited to the induction phase.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In our review of the literature we were interested to find 7 well-documented cases of relapses of AD or AD-like disease precipitated by infliximab.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–7</span></a> It is possible that more have not been reported because some relapses of AD may have been categorized as nonspecific eczema (AD has been considered to be a predictive factor for the appearance of eczema-like conditions in patients with psoriasis who receive infliximab),<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> because it is an underdiagnosed adverse effect, or because few cases have required aggressive treatment.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> The details of the cases we found and the case we report are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Almost all patients in the previously published cases had a history of AD and they only differed in the underlying disease for which infliximab had been prescribed. There is no clear pattern that defines the moment at which these reactions may develop, although all occurred within the first 2 years of treatment in these cases. Our patient required systemic treatment and we believe it is important to highlight that, despite the extent of his AD, the changes in laboratory findings in previous reports did not develop in our patient.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although our understanding of biologic therapies and the etiologic and pathogenic factors of AD increases daily, we are still unable to predict the onset of this type of adverse effect, which is surprising from a pathophysiological point of view. We hope that our presentation of this case will draw attention to the need to take a meticulous dermatology history in patients with AD who are candidates for biologic therapy, particularly in patients with rheumatic diseases or inflammatory bowel disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical Responsibilities</span><p id="par0060" class="elsevierStylePara elsevierViewall">Protection of persons and animals: The authors declare that the procedures followed adhere to the ethical guidelines of the responsible committee on human experimentation and comply with the Declaration of Helsinki of the World Medical Association. Data confidentiality: The authors declare that they have followed their hospital's protocol on the publication of data concerning patients and that all patients included in the study have received sufficient information and have given their written informed consent to participate in the study. Right to privacy and informed consent: The authors obtained informed consent from the patients and/or subjects referred to in this article. This document is held by the corresponding author.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical Responsibilities" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Ruiz-Villaverde R, Galán-Gutierrez M. Exacerbación de dermatitis atópica en paciente tratado con infliximab. Actas Dermosifiliogr.2012;103:743-746.</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" => 975 "Ancho" => 1300 "Tamanyo" => 180168 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Relapse of atopic dermatitis. State of the patient after the fifth infusion of infliximab.</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" => 974 "Ancho" => 1301 "Tamanyo" => 182262 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical improvement of our patient after 3 weeks of treatment with oral corticosteroids.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: AD: atopic dermatitis; IFX, infliximab.</p>" "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">Age, y \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">Sex \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">Underlying Disease \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">History of Atopy \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">Dosage \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">Timing of the Relapse of AD \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">Management \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (Wright RC<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-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 \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">Psoriasis \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">1st infusion \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">IFX continued. AD controlled with topical therapy \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">2 (Wright RC<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-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 \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">Rheumatoid arthritis \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">+/- \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">Not specified \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">IFX continued. AD controlled with topical therapy \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">3 (Vestergaard C 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-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \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">Suberythrodermic psoriasis<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>psoriatic arthropathy \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">7th infusion \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">IFX discontinued. AD controlled with ciclosporin \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">4 (Vestergaard C 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-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 \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">Pustular psoriasis \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">8th infusion \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">IFX discontinued. AD controlled with ciclosporin \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">5 (Chan JL 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-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \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">Psoriasis \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">2nd infusion \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">IFX continued. AD controlled with topical therapy \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">6 (Chan JL 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-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \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">Rheumatoid arthritis \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">7th infusion \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">IFX continued. AD controlled with topical therapy \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">7 (Chan JL 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-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \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">Crohn disease \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">3rd infusion \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">IFX discontinued. AD controlled with topical therapy \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">8 (Ruiz-Villaverde et al.) \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">30 \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">Ulcerative colitis \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">5th infusion \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">IFX discontinued. AD controlled with oral<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>topical corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182316.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patient and Clinical Characteristics and Course of Relapses of Atopic Dermatitis Precipitated by Infliximab.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous adverse events of biological therapy for psoriasis: review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.M. Thielen" 1 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 13 | 24 |
| 2024 October | 98 | 37 | 135 |
| 2024 September | 96 | 21 | 117 |
| 2024 August | 137 | 51 | 188 |
| 2024 July | 118 | 40 | 158 |
| 2024 June | 119 | 32 | 151 |
| 2024 May | 88 | 33 | 121 |
| 2024 April | 76 | 37 | 113 |
| 2024 March | 113 | 30 | 143 |
| 2024 February | 79 | 31 | 110 |
| 2024 January | 68 | 40 | 108 |
| 2023 December | 85 | 24 | 109 |
| 2023 November | 75 | 17 | 92 |
| 2023 October | 79 | 17 | 96 |
| 2023 September | 95 | 27 | 122 |
| 2023 August | 75 | 22 | 97 |
| 2023 July | 92 | 38 | 130 |
| 2023 June | 69 | 30 | 99 |
| 2023 May | 80 | 28 | 108 |
| 2023 April | 72 | 26 | 98 |
| 2023 March | 72 | 21 | 93 |
| 2023 February | 65 | 22 | 87 |
| 2023 January | 48 | 25 | 73 |
| 2022 December | 66 | 45 | 111 |
| 2022 November | 40 | 30 | 70 |
| 2022 October | 25 | 18 | 43 |
| 2022 September | 31 | 45 | 76 |
| 2022 August | 32 | 31 | 63 |
| 2022 July | 33 | 37 | 70 |
| 2022 June | 23 | 20 | 43 |
| 2022 May | 76 | 27 | 103 |
| 2022 April | 104 | 27 | 131 |
| 2022 March | 63 | 47 | 110 |
| 2022 February | 57 | 17 | 74 |
| 2022 January | 60 | 36 | 96 |
| 2021 December | 55 | 41 | 96 |
| 2021 November | 62 | 43 | 105 |
| 2021 October | 72 | 47 | 119 |
| 2021 September | 64 | 51 | 115 |
| 2021 August | 66 | 29 | 95 |
| 2021 July | 71 | 25 | 96 |
| 2021 June | 65 | 22 | 87 |
| 2021 May | 57 | 42 | 99 |
| 2021 April | 74 | 55 | 129 |
| 2021 March | 39 | 25 | 64 |
| 2021 February | 57 | 22 | 79 |
| 2021 January | 33 | 13 | 46 |
| 2020 December | 34 | 15 | 49 |
| 2020 November | 29 | 19 | 48 |
| 2020 October | 20 | 16 | 36 |
| 2020 September | 42 | 14 | 56 |
| 2020 August | 26 | 20 | 46 |
| 2020 July | 33 | 18 | 51 |
| 2020 June | 47 | 30 | 77 |
| 2020 May | 35 | 14 | 49 |
| 2020 April | 32 | 19 | 51 |
| 2020 March | 30 | 26 | 56 |
| 2020 February | 3 | 8 | 11 |
| 2020 January | 4 | 2 | 6 |
| 2019 December | 6 | 2 | 8 |
| 2019 November | 4 | 0 | 4 |
| 2019 October | 0 | 1 | 1 |
| 2019 August | 4 | 5 | 9 |
| 2019 July | 4 | 6 | 10 |
| 2019 June | 4 | 7 | 11 |
| 2019 May | 4 | 14 | 18 |
| 2019 April | 2 | 12 | 14 |
| 2019 March | 2 | 8 | 10 |
| 2019 February | 0 | 5 | 5 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 3 | 0 | 3 |
| 2018 May | 0 | 5 | 5 |
| 2018 March | 4 | 2 | 6 |
| 2018 February | 34 | 4 | 38 |
| 2018 January | 45 | 13 | 58 |
| 2017 December | 47 | 8 | 55 |
| 2017 November | 41 | 5 | 46 |
| 2017 October | 58 | 3 | 61 |
| 2017 September | 39 | 9 | 48 |
| 2017 August | 45 | 11 | 56 |
| 2017 July | 31 | 6 | 37 |
| 2017 June | 50 | 7 | 57 |
| 2017 May | 38 | 12 | 50 |
| 2017 April | 38 | 24 | 62 |
| 2017 March | 45 | 27 | 72 |
| 2017 February | 35 | 6 | 41 |
| 2017 January | 30 | 13 | 43 |
| 2016 December | 47 | 8 | 55 |
| 2016 November | 43 | 19 | 62 |
| 2016 October | 66 | 11 | 77 |
| 2016 September | 56 | 5 | 61 |
| 2016 August | 40 | 7 | 47 |
| 2016 July | 32 | 17 | 49 |
| 2016 June | 6 | 0 | 6 |
| 2016 May | 9 | 14 | 23 |
| 2016 April | 3 | 1 | 4 |
| 2016 March | 6 | 0 | 6 |
| 2016 February | 13 | 2 | 15 |
| 2016 January | 4 | 4 | 8 |
| 2015 December | 7 | 0 | 7 |
| 2015 November | 21 | 6 | 27 |
| 2015 October | 10 | 6 | 16 |
| 2015 September | 16 | 1 | 17 |
| 2015 August | 13 | 2 | 15 |
| 2015 July | 60 | 9 | 69 |
| 2015 June | 35 | 6 | 41 |
| 2015 May | 83 | 12 | 95 |
| 2015 April | 77 | 14 | 91 |
| 2015 March | 43 | 4 | 47 |
| 2015 February | 54 | 13 | 67 |
| 2015 January | 69 | 20 | 89 |
| 2014 December | 59 | 14 | 73 |
| 2014 November | 42 | 13 | 55 |
| 2014 October | 58 | 23 | 81 |
| 2014 September | 34 | 7 | 41 |
| 2014 August | 21 | 8 | 29 |
| 2014 July | 21 | 6 | 27 |
| 2014 June | 33 | 4 | 37 |
| 2014 May | 42 | 8 | 50 |
| 2014 April | 32 | 2 | 34 |
| 2014 March | 45 | 11 | 56 |
| 2014 February | 31 | 18 | 49 |
| 2014 January | 37 | 14 | 51 |
| 2013 December | 32 | 8 | 40 |
| 2013 November | 21 | 15 | 36 |
| 2013 October | 11 | 3 | 14 |
| 2013 September | 16 | 5 | 21 |
| 2013 August | 14 | 12 | 26 |
| 2013 July | 15 | 33 | 48 |
| 2013 June | 12 | 23 | 35 |
| 2013 May | 14 | 11 | 25 |
| 2013 April | 22 | 15 | 37 |
| 2013 March | 17 | 6 | 23 |
| 2013 February | 41 | 4 | 45 |
| 2013 January | 37 | 5 | 42 |
| 2012 December | 27 | 9 | 36 |
| 2012 November | 7 | 6 | 13 |
| 2012 October | 1 | 1 | 2 |
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