Case and Research Letter
Optic Neuritis Probably Induced by Isotretinoin
Neuritis óptica probablemente inducida por isotretinoína
L. Pérez-Pérez
, J. García-Gavín, F. Allegue, A. Zulaica
Corresponding author
Servicio de Dermatología, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
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Pérez-Pérez, J. García-Gavín, F. Allegue, A. Zulaica" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Pérez-Pérez" "email" => array:1 [ 0 => "lidiacomba@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "García-Gavín" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Allegue" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Zulaica" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de Vigo, Vigo, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neuritis óptica probablemente inducida por isotretinoína" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Isotretinoin is a drug indicated in dermatology for the treatment of acne and used off-label for other skin and mucosal disorders.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Most patients treated with isotretinoin develop mild adverse effects that do not affect the course of treatment. However, it can have less common unpredictable effects that are more serious and must be known by those who habitually use this drug in clinical practice.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A 16-year-old girl weighing 63<span class="elsevierStyleHsp" style=""></span>kg with no relevant past medical history or treatment for chronic disease was evaluated in our department for moderate, predominantly facial juvenile acne that had not been controlled with topical treatment (adapalene and benzoyl peroxide in combination) or oral antibiotics (oral doxycycline 50<span class="elsevierStyleHsp" style=""></span>mg for 2 months, interrupted 2 months before she started treatment with oral retinoids). Three months after starting treatment with oral isotretinoin (30<span class="elsevierStyleHsp" style=""></span>mg daily, 0.47<span class="elsevierStyleHsp" style=""></span>mg/kg/d), the patient began to notice vision loss and blurred vision in her right eye. She did not report pain with eye movements, impaired color vision, photophobia, or headache.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was evaluated by an ophthalmologist, who detected a peripheral visual field deficit in the right eye and established the clinical diagnosis of retrobulbar optic neuritis. Slit lamp examination and funduscopy showed normal findings in both eyes. The intraocular pressure was within the normal range in both eyes. On suspicion of an adverse reaction to isotretinoin, the patient was referred urgently to our clinic; when she attended she had reduced the daily dose from 30 to 20<span class="elsevierStyleHsp" style=""></span>mg and her vision had improved considerably. At that time it was decided to stop treatment. Nuclear magnetic resonance imaging was requested to rule out demyelinating disease and the patient was referred to the neurology department. The general neurological examination was normal. A lumbar puncture revealed no pathological findings. The visual evoked potential responses revealed P100 waves with prolonged latency, decreased amplitude, and altered morphology and confirmed the presence of bilateral optic neuropathy. The other additional tests revealed no pathological findings.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Six months after withdrawal of the drug, the patient had recovered vision completely and no ophthalmologic sequelae were observed in later examinations. The patient is studying abroad, so at the time of writing it has not been possible to confirm the return to normal values by repeating the ophthalmologic studies and visual evoked potentials.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A recent review of the adverse effects of isotretinoin in a series of 1743 patients showed that ocular manifestations may occur in up to 3.4% of cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The most common manifestations are mild cases of blurred vision, keratitis, and keratoconjunctivitis (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). However, there have been isolated reports of potentially serious ophthalmic adverse events.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Optic neuritis is an inflammatory disease of the optic nerve that is generally associated with acute or subacute loss of vision.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This condition is included in the list of possible adverse effects of isotretinoin in the drug's summary of product characteristics in some countries<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> and in several review articles.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a> Fraunfelder et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> reviewed a total of 2379 possible ocular adverse effects related to the administration of isotretinoin and identified 33 cases of optic neuritis, of which 22 occurred in women with a mean age of 25.6 years. Fraunfelder et al. classified optic neuritis as a “possible” ocular adverse effect of isotretinoin according to the World Health Organization classification system.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In our case, the timing, the improvement in symptoms after the initial dose reduction and subsequent interruption of the treatment, and the absence of other objective causes support the diagnosis of adverse drug reaction.</p><p id="par0045" class="elsevierStylePara elsevierViewall">It has recently been suggested that isotretinoin can cause alterations in synaptic activity and in the propagation of action potentials, leading to conduction defects within the optic nerve.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Visual evoked potentials may be useful for detecting and monitoring subclinical visual changes.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although most ocular adverse effects in patients treated with isotretinoin are mild and dose-dependent and do not interfere with the completion of the course of treatment, potentially serious ophthalmologic changes have been described. Providing patients with complete information and appropriate clinical monitoring can facilitate early detection of these effects and prevent long-term complications.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Pérez-Pérez L, et al. Neuritis óptica probablemente inducida por isotretinoína. Actas Dermosifiliogr. 2012;103:846-7.</p>" ] ] "multimedia" => array:1 [ 0 => 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Adverse Effect \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">Frequency, %<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blurred vision \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">19.9 \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">Keratitis \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">16.6 \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">Blepharoconjunctivitis \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">10.9 \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">Dry eye \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">10.2 \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">Decreased dark adaptation \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">5.9 \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">Corneal opacities \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></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">Intracranial hypertension \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">4.6 \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">Photophobia \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">3.7 \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">Refractive disorders \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">3.5 \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">Cataracts \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">2.1 \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">Altered accommodation, decreased tolerance to contact lenses, subconjunctival hemorrhage, optic neuritis, diplopia, iritis, mydriasis, palpebral angioedema, glaucoma, scleritis, decreased color vision, epiphora \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"><<span class="elsevierStyleHsp" style=""></span>2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182591.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara">Percentages of the total number of ocular adverse effects reported by Fraunfelder.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ocular Adverse Effects Most Frequently Induced by Isotretinoin.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uses and complications of isotretinoin therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.N. Ellis" 1 => "K.J. Krach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2001.113717" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2001" "volumen" => "45" "paginaInicial" => "S150" "paginaFinal" => "S157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11606947" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-Acne dermatologic indications for systemic isotretinoin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Akyol" 1 => "S. Ozçelik" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2005" "volumen" => "6" "paginaInicial" => "175" "paginaFinal" => "184" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15943494" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isotretinoin--Unapproved indications/uses and dosage: A physician's reference" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V.N. Sehgal" 1 => "G. Srivastava" 2 => "K. Sardana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2006.02830.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2006" "volumen" => "45" "paginaInicial" => "772" "paginaFinal" => "777" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16796650" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adverse effects of isotretinoin: A retrospective review of 1,743 patients started on isotretinoin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Rademaker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-0960.2010.00657.x" "Revista" => array:6 [ "tituloSerie" => "Australas J Dermatol" "fecha" => "2010" "volumen" => "51" "paginaInicial" => "248" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21198520" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preventing and managing the side effects of isotretinoin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Brelsford" 1 => "T.C. Beute" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.sder.2008.07.002" "Revista" => array:7 [ "tituloSerie" => "Semin Cutan Med Surg" "fecha" => "2008" "volumen" => "27" "paginaInicial" => "197" "paginaFinal" => "206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18786498" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0010782410006402" "estado" => "S300" "issn" => "00107824" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protocolo diagnóstico-terapéutico de la neuritis óptica en adultos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Planas" 1 => "S. Muñoz" 2 => "J. Arruga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Annals D’oftalmologia" "fecha" => "2009" "volumen" => "17" "paginaInicial" => "144" "paginaFinal" => "151" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Isotretinoína. Ficha técnica [Cited 25 Oct 2011]. Available at: <a class="elsevierStyleInterRef" href="http://prempharm.ca/Clarus%20Product%20Monograph.pdf">http://prempharm.ca/Clarus%20Product%20Monograph.pdf</a>" ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Isotretinoína. Ficha técnica [Cited 25 Oct 2011]. Available at: <a class="elsevierStyleInterRef" href="http://www.mufel.net/plm/prods/39004.htm">http://www.mufel.net/plm/prods/39004.htm</a>" ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ocular side effects associated with isotretinoin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.W. Fraunfelder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Drugs Today (Barc)" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "23" "paginaFinal" => "27" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ocular side effects possibly associated with isotretinoin usage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.T. Fraunfelder" 1 => "F.W. Fraunfelder" 2 => "R. Edwards" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2001" "volumen" => "132" "paginaInicial" => "299" "paginaFinal" => "305" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11530040" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety issues in isotretinoin therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Hanson" 1 => "S. Leachman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/sder.2001.28209" "Revista" => array:7 [ "tituloSerie" => "Semin Cutan Med Surg" "fecha" => "2001" "volumen" => "20" "paginaInicial" => "166" "paginaFinal" => "183" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11594672" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0010782409003564" "estado" => "S300" "issn" => "00107824" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurological and neurophysiological effects of oral isotretinoin: A prospective investigation using auditory and visual evoked potentials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Aydogan" 1 => "O.F. Turan" 2 => "S. Onart" 3 => "B. Yazici" 4 => "S.K. Karadogan" 5 => "N. Tokgoz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1684/ejd.2008.0512" "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2008" "volumen" => "18" "paginaInicial" => "642" "paginaFinal" => "646" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18955197" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000009/v1_201304241357/S1578219012002879/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/S1578219012002879/v1_201304241357/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012002879?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 22 | 15 | 37 |
| 2024 October | 183 | 64 | 247 |
| 2024 September | 222 | 74 | 296 |
| 2024 August | 256 | 120 | 376 |
| 2024 July | 226 | 74 | 300 |
| 2024 June | 229 | 83 | 312 |
| 2024 May | 205 | 72 | 277 |
| 2024 April | 166 | 62 | 228 |
| 2024 March | 202 | 103 | 305 |
| 2024 February | 156 | 136 | 292 |
| 2024 January | 142 | 140 | 282 |
| 2023 December | 145 | 87 | 232 |
| 2023 November | 96 | 94 | 190 |
| 2023 October | 104 | 94 | 198 |
| 2023 September | 110 | 68 | 178 |
| 2023 August | 74 | 74 | 148 |
| 2023 July | 97 | 139 | 236 |
| 2023 June | 113 | 84 | 197 |
| 2023 May | 193 | 92 | 285 |
| 2023 April | 124 | 78 | 202 |
| 2023 March | 154 | 73 | 227 |
| 2023 February | 103 | 77 | 180 |
| 2023 January | 86 | 81 | 167 |
| 2022 December | 90 | 121 | 211 |
| 2022 November | 34 | 166 | 200 |
| 2022 October | 47 | 180 | 227 |
| 2022 September | 39 | 142 | 181 |
| 2022 August | 26 | 120 | 146 |
| 2022 July | 26 | 115 | 141 |
| 2022 June | 37 | 90 | 127 |
| 2022 May | 199 | 129 | 328 |
| 2022 April | 220 | 114 | 334 |
| 2022 March | 156 | 136 | 292 |
| 2022 February | 132 | 142 | 274 |
| 2022 January | 112 | 141 | 253 |
| 2021 December | 127 | 112 | 239 |
| 2021 November | 112 | 134 | 246 |
| 2021 October | 74 | 148 | 222 |
| 2021 September | 55 | 103 | 158 |
| 2021 August | 47 | 101 | 148 |
| 2021 July | 57 | 108 | 165 |
| 2021 June | 50 | 121 | 171 |
| 2021 May | 51 | 212 | 263 |
| 2021 April | 117 | 279 | 396 |
| 2021 March | 45 | 130 | 175 |
| 2021 February | 56 | 93 | 149 |
| 2021 January | 58 | 93 | 151 |
| 2020 December | 51 | 91 | 142 |
| 2020 November | 37 | 47 | 84 |
| 2020 October | 30 | 58 | 88 |
| 2020 September | 43 | 30 | 73 |
| 2020 August | 36 | 67 | 103 |
| 2020 July | 25 | 49 | 74 |
| 2020 June | 41 | 70 | 111 |
| 2020 May | 20 | 56 | 76 |
| 2020 April | 32 | 45 | 77 |
| 2020 March | 30 | 47 | 77 |
| 2020 February | 8 | 39 | 47 |
| 2020 January | 4 | 45 | 49 |
| 2019 December | 8 | 39 | 47 |
| 2019 November | 2 | 26 | 28 |
| 2019 October | 0 | 59 | 59 |
| 2019 September | 8 | 28 | 36 |
| 2019 August | 4 | 34 | 38 |
| 2019 July | 4 | 52 | 56 |
| 2019 June | 6 | 38 | 44 |
| 2019 May | 4 | 113 | 117 |
| 2019 April | 2 | 78 | 80 |
| 2019 March | 2 | 20 | 22 |
| 2019 February | 2 | 12 | 14 |
| 2019 January | 2 | 1 | 3 |
| 2018 December | 5 | 7 | 12 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 4 | 19 | 23 |
| 2018 August | 0 | 20 | 20 |
| 2018 July | 0 | 17 | 17 |
| 2018 June | 0 | 9 | 9 |
| 2018 May | 0 | 3 | 3 |
| 2018 April | 0 | 7 | 7 |
| 2018 March | 17 | 7 | 24 |
| 2018 February | 72 | 19 | 91 |
| 2018 January | 72 | 11 | 83 |
| 2017 December | 87 | 16 | 103 |
| 2017 November | 74 | 19 | 93 |
| 2017 October | 76 | 14 | 90 |
| 2017 September | 84 | 17 | 101 |
| 2017 August | 101 | 18 | 119 |
| 2017 July | 97 | 42 | 139 |
| 2017 June | 92 | 39 | 131 |
| 2017 May | 76 | 26 | 102 |
| 2017 April | 89 | 27 | 116 |
| 2017 March | 85 | 36 | 121 |
| 2017 February | 75 | 26 | 101 |
| 2017 January | 113 | 21 | 134 |
| 2016 December | 105 | 16 | 121 |
| 2016 November | 160 | 20 | 180 |
| 2016 October | 120 | 12 | 132 |
| 2016 September | 148 | 28 | 176 |
| 2016 August | 121 | 27 | 148 |
| 2016 July | 82 | 31 | 113 |
| 2016 June | 12 | 20 | 32 |
| 2016 May | 5 | 16 | 21 |
| 2016 April | 4 | 1 | 5 |
| 2016 March | 8 | 16 | 24 |
| 2016 February | 9 | 1 | 10 |
| 2016 January | 13 | 1 | 14 |
| 2015 December | 19 | 1 | 20 |
| 2015 November | 20 | 6 | 26 |
| 2015 October | 17 | 5 | 22 |
| 2015 September | 13 | 1 | 14 |
| 2015 August | 14 | 8 | 22 |
| 2015 July | 65 | 7 | 72 |
| 2015 June | 65 | 7 | 72 |
| 2015 May | 126 | 9 | 135 |
| 2015 April | 88 | 16 | 104 |
| 2015 March | 87 | 8 | 95 |
| 2015 February | 69 | 7 | 76 |
| 2015 January | 65 | 11 | 76 |
| 2014 December | 54 | 12 | 66 |
| 2014 November | 60 | 11 | 71 |
| 2014 October | 38 | 8 | 46 |
| 2014 September | 23 | 5 | 28 |
| 2014 August | 23 | 3 | 26 |
| 2014 July | 23 | 9 | 32 |
| 2014 June | 23 | 7 | 30 |
| 2014 May | 31 | 8 | 39 |
| 2014 April | 21 | 4 | 25 |
| 2014 March | 27 | 8 | 35 |
| 2014 February | 26 | 17 | 43 |
| 2014 January | 30 | 13 | 43 |
| 2013 December | 36 | 16 | 52 |
| 2013 November | 17 | 12 | 29 |
| 2013 October | 8 | 15 | 23 |
| 2013 September | 12 | 13 | 25 |
| 2013 August | 9 | 20 | 29 |
| 2013 July | 13 | 24 | 37 |
| 2013 June | 8 | 18 | 26 |
| 2013 May | 10 | 22 | 32 |
| 2013 April | 10 | 29 | 39 |
| 2013 March | 20 | 13 | 33 |
| 2013 February | 35 | 9 | 44 |
| 2013 January | 20 | 9 | 29 |
| 2012 December | 15 | 8 | 23 |
| 2012 November | 1 | 0 | 1 |
Show all
