Case and Research Letter
Cutaneous Infection in a Tattoo Due to Mycobacterium Chelonae: A Report of 2 Cases and a Review of the Literature
Infección cutánea por Mycobacterium chelonae en un tatuaje. Presentación de 2 casos y revisión de la literatura
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Presentación de 2 casos y revisión de la literatura" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "840" "paginaFinal" => "843" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cutaneous Infection in a Tattoo Due to <span class="elsevierStyleItalic">Mycobacterium Chelonae</span>: A Report of 2 Cases and a Review of the Literature" ] ] "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" => 1370 "Ancho" => 978 "Tamanyo" => 317042 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Caso 2. A. 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Curcó, C. Prat, X. Tarroch, P. Vives" "autores" => array:4 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Curcó" "email" => array:1 [ 0 => "ncurco@mutuaterrassa.es" ] "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" => "C." "apellidos" => "Prat" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "X." "apellidos" => "Tarroch" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "Vives" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitari Mútua de Terrassa, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitari Mútua de Terrassa, Barcelona, 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" => "Infección cutánea por <span class="elsevierStyleItalic">Mycobacterium chelonae</span> en un tatuaje. Presentación de 2 casos y revisión de la literatura" ] ] "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" => 2285 "Ancho" => 1632 "Tamanyo" => 393591 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient 2. A, Erythematous papule in the gray area of a petal of the flower. B, Accumulation of acid-alcohol-fast bacteria in the area with abscess formation (Kinyoun, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>400).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Skin complications arising from tattoos include contact dermatitis, photodermatosis, lichenoid reactions, granulomas (foreign body, sarcoid), and infection.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Small outbreaks of skin infections due to <span class="elsevierStyleItalic">Mycobacterium chelonae</span> in contaminated tattoo ink have recently been reported.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patient 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">Patient 1 was a 33-year-old man who had had a tattoo placed on his right leg 4 years previously. Three months before consulting, he had the shield outlined in black and a gray flame added. Asymptomatic lesions appeared 2 weeks later and were treated unsuccessfully with topical corticosteroids and antibiotics. The patient was then referred to the dermatology department.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination of the gray flame revealed several papulopustules measuring 1<span class="elsevierStyleHsp" style=""></span>mm to 4<span class="elsevierStyleHsp" style=""></span>mm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The border drawn in black ink the same day was not affected. Analysis of a biopsy specimen revealed granulomas with abscess formation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B); Kinyoun staining was negative. <span class="elsevierStyleItalic">M chelonae</span> grew in culture 15 days later. The chest x-ray was normal, and laboratory tests (including serology for HIV and hepatitis) were negative. The patient was treated empirically with clarithromycin (500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) for 3 months. The lesions disappeared.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patient 2</span><p id="par0020" class="elsevierStylePara elsevierViewall">Patient 2 was a 25-year-old woman who had had a black and grey tattoo placed on the dorsum of the foot 5 months previously by the same tattoo artist. Five days later, an asymptomatic lesion appeared on the gray areas. The lesion had been treated unsuccessfully with topical antibiotics and corticosteroids. Physical examination revealed an erythematous plaque measuring 1<span class="elsevierStyleHsp" style=""></span>cm in diameter that was soft to palpation with occasional pustules on its surface (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Analysis of a biopsy specimen revealed granulomas with abscess formation; Kinyoun staining showed a small accumulation of acid-alcohol-fast bacteria (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B), but culture was negative. The patient was treated with clarithromycin (500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h), although the drug was withdrawn in less than a month because of digestive tract intolerance. As the lesion had disappeared, no further treatment was administered.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M chelonae</span> is a fast-growing saprophytic mycobacterium that is found in tap water and water tanks and can contaminate surgical material. Skin infections have been reported in surgery, acupuncture, mesotherapy, and tattooing. In the case of tattoos, the infections affect the gray areas, as nonsterile water is added to the black ink.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The first case of a tattoo infected by mycobacteria was reported in 2003. Diagnosis was based on Ziehl-Neelsen staining and positive results in polymerase chain reaction (PCR) analysis. De Quatrebarbes et al<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> later reported the first epidemic of <span class="elsevierStyleItalic">M chelonae</span> in tattoos. Twenty men presented with a rash in the gray area of their tattoos 7 to 10 days after having them performed by the same artist. Culture was positive for <span class="elsevierStyleItalic">M chelonae</span> in 13 patients.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Goldman et al<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> subsequently included these patients in a letter reporting on 48 patients who were tattooed by 2 different artists in Le Havre, France. <span class="elsevierStyleItalic">M chelonae</span> was found in 2 bottles of diluted black ink. New cases have since been reported in France,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Australia,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and the United States.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Rodríguez-Blanco et al<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> recently reported 5 cases in La Coruña, Spain; 3 were culture-positive and 2 PCR-positive. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the cases published to date.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">All the cases involved the appearance of papulopustules in the gray areas of the tattoo 1 to 2 weeks after placement. No systemic involvement was recorded. The diagnostic delay (1-5 mo) is noteworthy, as the patients were initially diagnosed with an allergic reaction or bacterial infection and were treated with topical antibiotics, corticosteroids, or both. No standard treatment has been defined, although the most widely used agent is clarithromycin, which, according to Drage et al,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> should be prescribed for at least 6 months; however, digestive tract intolerance makes this difficult.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Some clinicians have combined clarithromycin with quinolones<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>; others have found a 1-month course of minocycline to be successful.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The tattoo artist claimed to have used disposable material with each patient. The gray color was obtained by mixing black ink with rose water bought at the pharmacy. We assume that this water or the mixture became contaminated and was thus the cause of the infection, although we were unable to verify this, as all the material had been disposed of.</p><p id="par0045" class="elsevierStylePara elsevierViewall">As tattooing is increasingly common, we wish to stress the importance of using disposable material and sterile products in order to avoid this type of infection. Furthermore, black ink should be mixed with sterile saline or water when the tattoo is being placed in order to avoid subsequent contamination; the mixture should not be stored.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Clinicians should suspect this infection and be able to recognize it, since staining is usually negative and culture positive in only 40% to 60% of cases. New PCR techniques can help to confirm the diagnosis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Patient 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Patient 2" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Curcó N, et al. Infección cutánea por Mycobacterium chelonae en un tatuaje. Presentación de 2 casos y revisión de la literatura. Actas Dermosifiliogr. 2012;103:842-5.</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" => 2285 "Ancho" => 1632 "Tamanyo" => 563763 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient 1. A, Papulopustules only affecting the gray area of the flame. B, Granuloma with abscess formation and occasional giant cells (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>200).</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" => 2285 "Ancho" => 1632 "Tamanyo" => 393591 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient 2. A, Erythematous papule in the gray area of a petal of the flower. B, Accumulation of acid-alcohol-fast bacteria in the area with abscess formation (Kinyoun, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>400).</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: ND, no data.</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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Author/Year/Country \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">No. of Cases \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">Time to Appearance \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">Time to Diagnosis \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">Histology \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">Mycobacterial Staining \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">Culture \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">Treatment \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">Wolf and Wolf/2003<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>/Israel \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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">ND \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 mo \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">Granulomatous dermatitis \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">PCR<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>atypical mycobacteria \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Goldman et al./2010<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>/France<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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \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">3-35 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">2 mo (mean) \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">50% granulomas \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">ND<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</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">13+/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">Clarithromycin in 41 patients<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>tobramycin (10 patients) \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">Kluger et al./2008<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>/France \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \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">10-21 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">2-5 mo \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">Inflammatory dermatitis and granulomatous reaction \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">– (+ in ink) \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">Minocycline (1 mo) \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">Preda et al./2009<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>/Australia \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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">2 mo \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">Inflammatory and granulomatous dermatitis \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">ND \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">Clarithromycin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>moxifloxacin4 mo \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">Drage et al./2010<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>/United States \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \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">1-2 wk \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">Mean 17.6 (range, 10-22) wk \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">Inflammatory dermatitis (3 cases)Granulomatous dermatitis (3 cases) \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+/6 \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">Clarithromycin 6 mo \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">Rodríguez-Blanco et al./2010<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>/Spain \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \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">3-30 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">ND \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">Inflammatory dermatitis (3 cases)Granulomatous dermatitis (2 cases) \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 + \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">Clarithromycin 3-5 mo (2 patients) \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">Kappel and Cotliar/2011<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>/United States \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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 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">2 wk \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">Inflammatory and granulomatous dermatitis \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">ND \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">Clarithromycin and levofloxacin, 6 mo \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">Present report, 2011 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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">5-15 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">3-5 mo \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">Granulomatous dermatitis \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">1+ \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">1+ \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">Clarithromycin, 1-3 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182587.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara">Includes 20 cases reported by De Quatrebarbes et al<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> in 2005.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara">The article by De Quatrebarbes et al<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> appears to include some positive cases, although the exact number is not given.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cases of Skin Infection by <span class="elsevierStyleItalic">Mycobacterium chelonae</span> in Tattoos.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reacciones cutáneas adversas por tatuajes y piercings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. 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Almagro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2340/00015555-1034" "Revista" => array:6 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "2011" "volumen" => "91" "paginaInicial" => "61" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21264454" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000009/v1_201304241357/S1578219012002867/v1_201304241357/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000009/v1_201304241357/S1578219012002867/v1_201304241357/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012002867?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 8 | 18 |
| 2024 October | 103 | 47 | 150 |
| 2024 September | 112 | 43 | 155 |
| 2024 August | 138 | 75 | 213 |
| 2024 July | 127 | 44 | 171 |
| 2024 June | 128 | 50 | 178 |
| 2024 May | 89 | 44 | 133 |
| 2024 April | 96 | 36 | 132 |
| 2024 March | 97 | 28 | 125 |
| 2024 February | 69 | 30 | 99 |
| 2024 January | 66 | 45 | 111 |
| 2023 December | 81 | 39 | 120 |
| 2023 November | 82 | 26 | 108 |
| 2023 October | 80 | 47 | 127 |
| 2023 September | 82 | 35 | 117 |
| 2023 August | 61 | 18 | 79 |
| 2023 July | 97 | 56 | 153 |
| 2023 June | 61 | 31 | 92 |
| 2023 May | 93 | 24 | 117 |
| 2023 April | 72 | 25 | 97 |
| 2023 March | 55 | 36 | 91 |
| 2023 February | 48 | 23 | 71 |
| 2023 January | 41 | 34 | 75 |
| 2022 December | 61 | 52 | 113 |
| 2022 November | 27 | 29 | 56 |
| 2022 October | 34 | 28 | 62 |
| 2022 September | 46 | 43 | 89 |
| 2022 August | 40 | 39 | 79 |
| 2022 July | 40 | 35 | 75 |
| 2022 June | 32 | 35 | 67 |
| 2022 May | 70 | 55 | 125 |
| 2022 April | 112 | 57 | 169 |
| 2022 March | 78 | 59 | 137 |
| 2022 February | 90 | 42 | 132 |
| 2022 January | 114 | 42 | 156 |
| 2021 December | 76 | 47 | 123 |
| 2021 November | 105 | 51 | 156 |
| 2021 October | 76 | 54 | 130 |
| 2021 September | 69 | 44 | 113 |
| 2021 August | 45 | 31 | 76 |
| 2021 July | 51 | 30 | 81 |
| 2021 June | 51 | 27 | 78 |
| 2021 May | 42 | 34 | 76 |
| 2021 April | 147 | 67 | 214 |
| 2021 March | 77 | 62 | 139 |
| 2021 February | 98 | 25 | 123 |
| 2021 January | 40 | 26 | 66 |
| 2020 December | 27 | 17 | 44 |
| 2020 November | 49 | 19 | 68 |
| 2020 October | 40 | 8 | 48 |
| 2020 September | 72 | 8 | 80 |
| 2020 August | 48 | 18 | 66 |
| 2020 July | 67 | 14 | 81 |
| 2020 June | 34 | 24 | 58 |
| 2020 May | 44 | 21 | 65 |
| 2020 April | 712 | 22 | 734 |
| 2020 March | 32 | 18 | 50 |
| 2020 February | 3 | 9 | 12 |
| 2020 January | 4 | 2 | 6 |
| 2019 December | 4 | 2 | 6 |
| 2019 November | 6 | 4 | 10 |
| 2019 October | 0 | 13 | 13 |
| 2019 September | 3 | 2 | 5 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 10 | 14 |
| 2019 June | 4 | 15 | 19 |
| 2019 May | 4 | 27 | 31 |
| 2019 April | 2 | 24 | 26 |
| 2019 March | 0 | 7 | 7 |
| 2019 February | 2 | 2 | 4 |
| 2018 December | 3 | 5 | 8 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 6 | 0 | 6 |
| 2018 March | 7 | 1 | 8 |
| 2018 February | 46 | 2 | 48 |
| 2018 January | 52 | 5 | 57 |
| 2017 December | 60 | 6 | 66 |
| 2017 November | 51 | 0 | 51 |
| 2017 October | 33 | 5 | 38 |
| 2017 September | 40 | 8 | 48 |
| 2017 August | 42 | 9 | 51 |
| 2017 July | 40 | 8 | 48 |
| 2017 June | 58 | 8 | 66 |
| 2017 May | 43 | 4 | 47 |
| 2017 April | 31 | 10 | 41 |
| 2017 March | 37 | 4 | 41 |
| 2017 February | 39 | 8 | 47 |
| 2017 January | 38 | 5 | 43 |
| 2016 December | 65 | 9 | 74 |
| 2016 November | 81 | 4 | 85 |
| 2016 October | 74 | 14 | 88 |
| 2016 September | 93 | 4 | 97 |
| 2016 August | 91 | 12 | 103 |
| 2016 July | 41 | 8 | 49 |
| 2016 June | 7 | 0 | 7 |
| 2016 May | 10 | 0 | 10 |
| 2016 April | 4 | 1 | 5 |
| 2016 March | 9 | 0 | 9 |
| 2016 February | 4 | 0 | 4 |
| 2016 January | 4 | 1 | 5 |
| 2015 December | 6 | 0 | 6 |
| 2015 November | 18 | 2 | 20 |
| 2015 October | 10 | 2 | 12 |
| 2015 September | 7 | 9 | 16 |
| 2015 August | 11 | 4 | 15 |
| 2015 July | 76 | 12 | 88 |
| 2015 June | 62 | 6 | 68 |
| 2015 May | 100 | 10 | 110 |
| 2015 April | 90 | 14 | 104 |
| 2015 March | 82 | 8 | 90 |
| 2015 February | 72 | 10 | 82 |
| 2015 January | 74 | 7 | 81 |
| 2014 December | 98 | 11 | 109 |
| 2014 November | 69 | 19 | 88 |
| 2014 October | 60 | 8 | 68 |
| 2014 September | 34 | 7 | 41 |
| 2014 August | 32 | 7 | 39 |
| 2014 July | 33 | 7 | 40 |
| 2014 June | 48 | 3 | 51 |
| 2014 May | 55 | 7 | 62 |
| 2014 April | 49 | 6 | 55 |
| 2014 March | 79 | 5 | 84 |
| 2014 February | 50 | 10 | 60 |
| 2014 January | 45 | 8 | 53 |
| 2013 December | 36 | 8 | 44 |
| 2013 November | 39 | 10 | 49 |
| 2013 October | 13 | 3 | 16 |
| 2013 September | 14 | 3 | 17 |
| 2013 August | 17 | 3 | 20 |
| 2013 July | 11 | 14 | 25 |
| 2013 June | 16 | 7 | 23 |
| 2013 May | 15 | 1 | 16 |
| 2013 April | 16 | 8 | 24 |
| 2013 March | 20 | 7 | 27 |
| 2013 February | 35 | 1 | 36 |
| 2013 January | 23 | 5 | 28 |
| 2012 December | 28 | 16 | 44 |
Show all
