array:23 [
  "pii" => "S1578219013001418"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2013.04.012"
  "estado" => "S300"
  "fechaPublicacion" => "2013-09-01"
  "aid" => "843"
  "copyright" => "Elsevier España, S.L. and AEDV"
  "copyrightAnyo" => "2013"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "sco"
  "cita" => "Actas Dermosifiliogr. 2013;104:541-2"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3768
    "formatos" => array:3 [
      "EPUB" => 50
      "HTML" => 2979
      "PDF" => 739
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731013001622"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2013.04.004"
      "estado" => "S300"
      "fechaPublicacion" => "2013-09-01"
      "aid" => "843"
      "copyright" => "Elsevier España, S.L. and AEDV"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "sco"
      "cita" => "Actas Dermosifiliogr. 2013;104:541-2"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4654
        "formatos" => array:3 [
          "EPUB" => 2
          "HTML" => 2959
          "PDF" => 1693
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Art&#237;culo de opini&#243;n</span>"
        "titulo" => "Proyecto dosis eritematosa m&#237;nima &#40;DEM&#41;&#58; en busca del consenso en la t&#233;cnica del fototest"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "541"
            "paginaFinal" => "542"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The Minimal Erythema Dose &#40;MED&#41; Project&#58; In Search of Consensus on Photopatch Testing"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A&#46; P&#233;rez-Ferriols"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "P&#233;rez-Ferriols"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219013001418"
          "doi" => "10.1016/j.adengl.2013.04.012"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001418?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013001622?idApp=UINPBA000044"
      "url" => "/00017310/0000010400000007/v1_201308270831/S0001731013001622/v1_201308270831/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S157821901300142X"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2012.05.026"
    "estado" => "S300"
    "fechaPublicacion" => "2013-09-01"
    "aid" => "637"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "ssu"
    "cita" => "Actas Dermosifiliogr. 2013;104:543-53"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 12534
      "formatos" => array:3 [
        "EPUB" => 53
        "HTML" => 11363
        "PDF" => 1118
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Cutaneous Manifestations of Systemic Malignancies&#58; Part 2"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "543"
          "paginaFinal" => "553"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Alertas cut&#225;neas en malignidades sist&#233;micas &#40;parte 2&#41;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0065"
          "etiqueta" => "Figure 14"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr14.jpeg"
              "Alto" => 1532
              "Ancho" => 1583
              "Tamanyo" => 261176
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Yellow nail syndrome&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Yuste Chaves, P&#46; Unamuno P&#233;rez"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Yuste Chaves"
            ]
            1 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Unamuno P&#233;rez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731012002219"
        "doi" => "10.1016/j.ad.2012.05.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012002219?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901300142X?idApp=UINPBA000044"
    "url" => "/15782190/0000010400000007/v1_201308270818/S157821901300142X/v1_201308270818/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Opinion Article</span>"
    "titulo" => "The Minimal Erythema Dose &#40;MED&#41; Project&#58; In Search of Consensus on Phototesting"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "541"
        "paginaFinal" => "542"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "A&#46; P&#233;rez-Ferriols"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "P&#233;rez-Ferriols"
            "email" => array:1 [
              0 => "perez&#95;ampferr&#64;gva&#46;es"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital General Universitario de Valencia&#44; Valencia&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Proyecto dosis eritematosa m&#237;nima &#40;DEM&#41;&#58; en busca del consenso en la t&#233;cnica del fototest"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The examination of a patient who presents with photosensitivity requires us to obtain a targeted medical history by asking the right questions and to perform an appropriate physical examination complemented by tests&#44; such as skin biopsy&#44; laboratory workup&#44; and direct immunofluorescence&#44; as required&#44; all of which are available in most general dermatology departments&#46; These elements provide the necessary basis for reaching a diagnosis in a high percentage of cases&#46; However&#44; a complete photobiological study requires more specific tests that are available only in specialized photobiology departments that have the necessary equipment and medical personnel trained to perform&#44; read&#44; and interpret the tests&#46; One of the basic techniques used in such departments is phototesting&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Phototesting can be used to determine the patient&#39;s minimal erythema dose &#40;MED&#41;&#44; which is defined as the dose of UV-B radiation that produces perceptible erythema 24<span class="elsevierStyleHsp" style=""></span>hours after administration&#46; It can also be used to determine abnormal reactions to UV-A radiation and visible light&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Though this procedure may at first seem simple&#44; it is complicated by a number of factors and the resulting MED value will depend on the subjective interpretation of the observer&#44; the skin site tested&#44; the patient&#39;s age&#44; the ambient temperature&#44; the degree of pigmentation of the patient&#39;s skin&#44; and of course their phototype&#46; Furthermore&#44; individuals with the same phototype can have different MEDs&#44; possibly because of the factors mentioned above&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">All these factors make it difficult to determine whether a patient presenting with photosensitivity has a reduced MED if we have no baseline data&#46; Moreover&#44; it has been observed that in up to 68&#37; of patients with photosensitivity the MED value is normal&#44; a finding indicating that this figure is of only relative value<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in prevalent dermatoses such as polymorphic light eruption and the less frequent photodermatitis and actinic prurigo&#46; In other photodermatoses&#44; such as solar urticaria&#44; the phototest usually becomes a veritable challenge test and we take an immediate reading to determine the minimal urticarial dose at each wavelength tested&#46; In chronic actinic dermatitis&#44; a decrease in the MED is a diagnostic criterion and its detection is therefore a great aid to diagnosis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">As if the interpretation of these results was not already sufficiently problematic&#44; those of us who attend meetings of the Spanish Photobiology Group have been puzzled and concerned by apparently glaring inconsistencies in the MED values obtained using phototesting reported in some presentations&#59; in some cases&#44; MED values have even been stated in terms of time &#40;seconds&#41; rather than doses&#46; Furthermore&#44; even when MED values have been given in units of energy per unit area &#40;mJ&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#44; the results reported by different working groups for individuals who theoretically have the same phototype have varied by as much as 50 to 70<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#46; These findings were incomprehensible because the light sources used in the majority of departments are similar&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In view of this situation and the lack of any consensus on standards in either the Spanish or English literature&#44; in 2010 the Spanish Photobiology Group recognized the need to undertake a joint project to unify standards&#46; The Spanish Photobiology Group is a multidisciplinary working group within the Spanish Academy of Dermatology and Venereology&#46; In this group dermatologists have worked side by side with biologists&#44; physicists&#44; chemists&#44; pharmacists&#44; meteorologists&#44; and astronomers for almost 25 years&#46; This collaboration allows the same problem to be approached from different standpoints by experts in each field&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The first step in our project was to collect information on the methods used to perform phototesting in each photobiology department&#46; A total of 9 Spanish hospitals participated in the project and physicists&#44; meteorologists&#44; and biologists also provided their expertise&#44; time&#44; and equipment&#46; Together we achieved an enhanced understanding of our light sources&#44; which are mainly xenon arc solar simulators and broadband UV-B fluorescent lamps&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We calibrated all the equipment at practically the same time in all the participating institutions&#44; a measure that some members of the group had been requesting for years&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Solar simulators in particular are simple but highly sensitive devices&#44; and even the handling required to perform the test can alter the arrangement of the mirror systems that direct the light beam&#46; Each light source was characterized spectrally using a spectroradiometer to determine the erythemal irradiance &#40;ability to produce erythema&#41; of each wavelength&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This procedure revealed the cause of the discrepancies in the radiation doses used by the groups&#44; making everyone aware of the erythemal weighting function&#44; a function used by physicists and biologists but little known to dermatologists which takes into account the ability to produce erythema of each wavelength of the light source&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The group defined a methodology for phototesting&#44; which specified the need to identify the ideal anatomical region&#44; the diameter of each irradiated area&#44; the distance between the irradiated areas&#44; and the reading times&#46; On the basis of previous experience&#44; different series of exploratory doses were specified for departments using solar simulators and for departments using broadband UVB lamps&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The participants in the project performed phototesting on a healthy Spanish population&#46; The primary aim was to identify the MED thresholds for the main skin phototypes and to standardize the doses and units of measurement used by all centers performing phototesting&#46; In addition&#44; we tried to establish the cutoff points for each group below which a MED value would indicate photosensitivity&#44; especially for skin phototypes II and III&#44; the largest groups in the study population and probably those most representative of the Spanish population as a whole&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">This project also opened discussion on the usefulness of this procedure in dermatoses such as polymorphic light eruption and actinic prurigo&#44; in view of the high percentage of normal results reported in the literature and by those who perform the test regularly&#46; In these settings&#44; it may be recommendable to perform challenge tests &#40;repeated application of various MEDs at the same location over several days&#41; although these tests are not always relevant and are time-consuming for patients and medical personnel&#46; Furthermore&#44; their usefulness in this setting has been seriously questioned by Spanish photobiologists&#46; In my opinion&#44; for the diagnosis of these diseases it would be more appropriate to obtain a biopsy of the skin lesions and&#44; in the case of polymorphic light eruption&#44; to perform direct immunofluorescence and determine circulating autoantibody titers to rule out lupus erythematosus&#46; However&#44; these diagnostic procedures would not be appropriate in solar urticaria and chronic actinic dermatitis&#44; or in certain cases of systemic drug-induced photosensitivity&#46; In the cases of drug-induced photosensitivity&#44; measurement of the decrease in MED values following administration of the suspected drug would also be very helpful in diagnosis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The results of the project&#44; soon to be published in this journal&#44; will provide a working methodology for all those who perform phototests and of particular value to novices in the technique&#46; The present project&#44; together with the publication of a study that will lay the foundations for the new European photoallergen battery&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> to which Spain has made a large contribution&#44; provides clear evidence of the steady progress toward standardization being made by clinical photobiology&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; P&#233;rez-Ferriols A&#46; Proyecto dosis eritematosa m&#237;nima &#40;DEM&#41;&#58; en busca del consenso en la t&#233;cnica del fototest&#46; Actas Dermosifiliogr&#46; 2013&#59;104&#58;541&#8211;2&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultraviolet radiation-induced erytema in human skin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Graham"
                            1 => "Harrison"
                            2 => "A&#46;R&#46; Young"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Methods"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "paginaInicial" => "14"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12231183"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normal minimal erythema dose responses in patients with suspected photosensitivity disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Keena"
                            1 => "T&#46; Que"
                            2 => "J&#46; Brauer"
                            3 => "N&#46; Soter"
                            4 => "D&#46; Cohen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Photoderm Photimmunol Photomed"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "320"
                        "paginaFinal" => "321"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Algunas evidencias cl&#237;nicas sobre la necesidad del calibrado de simuladores solares usados en dermatolog&#237;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Mart&#237;nez Lozano"
                            1 => "M&#46;P&#46; Utrillas Esteban"
                            2 => "R&#46; Pedr&#243;s Esteban"
                            3 => "F&#46; Tena Sang&#252;esa"
                            4 => "J&#46; de la Cuadra Oyanguren"
                            5 => "A&#46; P&#233;rez Ferriols"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr&#46;"
                        "fecha" => "2001"
                        "volumen" => "92"
                        "paginaInicial" => "444"
                        "paginaFinal" => "451"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A European multicentre photopatch test study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "The European Multicentre Photopatch Test Study &#40;EMCPPTS&#41; Taskforce"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2012.10857.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br&#46; J&#46; Dermatol&#46;"
                        "fecha" => "2012"
                        "volumen" => "166"
                        "paginaInicial" => "1002"
                        "paginaFinal" => "1009"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22283432"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010400000007/v1_201308270818/S1578219013001418/v1_201308270818/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6152"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Opinion Article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000007/v1_201308270818/S1578219013001418/v1_201308270818/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001418?idApp=UINPBA000044"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Opinion Article
The Minimal Erythema Dose (MED) Project: In Search of Consensus on Phototesting
Proyecto dosis eritematosa mínima (DEM): en busca del consenso en la técnica del fototest
A. Pérez-Ferriols
Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain
Read
12313
Times
was read the article
2745
Total PDF
9568
Total HTML
Share statistics
 array:23 [
  "pii" => "S1578219013001418"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2013.04.012"
  "estado" => "S300"
  "fechaPublicacion" => "2013-09-01"
  "aid" => "843"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
  "copyrightAnyo" => "2013"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "sco"
  "cita" => "Actas Dermosifiliogr. 2013;104:541-2"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3768
    "formatos" => array:3 [
      "EPUB" => 50
      "HTML" => 2979
      "PDF" => 739
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731013001622"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2013.04.004"
      "estado" => "S300"
      "fechaPublicacion" => "2013-09-01"
      "aid" => "843"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "sco"
      "cita" => "Actas Dermosifiliogr. 2013;104:541-2"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4654
        "formatos" => array:3 [
          "EPUB" => 2
          "HTML" => 2959
          "PDF" => 1693
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Art&#237;culo de opini&#243;n</span>"
        "titulo" => "Proyecto dosis eritematosa m&#237;nima &#40;DEM&#41;&#58; en busca del consenso en la t&#233;cnica del fototest"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "541"
            "paginaFinal" => "542"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The Minimal Erythema Dose &#40;MED&#41; Project&#58; In Search of Consensus on Photopatch Testing"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A&#46; P&#233;rez-Ferriols"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "P&#233;rez-Ferriols"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219013001418"
          "doi" => "10.1016/j.adengl.2013.04.012"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001418?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013001622?idApp=UINPBA000044"
      "url" => "/00017310/0000010400000007/v1_201308270831/S0001731013001622/v1_201308270831/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S157821901300142X"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2012.05.026"
    "estado" => "S300"
    "fechaPublicacion" => "2013-09-01"
    "aid" => "637"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "ssu"
    "cita" => "Actas Dermosifiliogr. 2013;104:543-53"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 12534
      "formatos" => array:3 [
        "EPUB" => 53
        "HTML" => 11363
        "PDF" => 1118
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Cutaneous Manifestations of Systemic Malignancies&#58; Part 2"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "543"
          "paginaFinal" => "553"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Alertas cut&#225;neas en malignidades sist&#233;micas &#40;parte 2&#41;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0065"
          "etiqueta" => "Figure 14"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr14.jpeg"
              "Alto" => 1532
              "Ancho" => 1583
              "Tamanyo" => 261176
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Yellow nail syndrome&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Yuste Chaves, P&#46; Unamuno P&#233;rez"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Yuste Chaves"
            ]
            1 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Unamuno P&#233;rez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731012002219"
        "doi" => "10.1016/j.ad.2012.05.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012002219?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901300142X?idApp=UINPBA000044"
    "url" => "/15782190/0000010400000007/v1_201308270818/S157821901300142X/v1_201308270818/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Opinion Article</span>"
    "titulo" => "The Minimal Erythema Dose &#40;MED&#41; Project&#58; In Search of Consensus on Phototesting"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "541"
        "paginaFinal" => "542"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "A&#46; P&#233;rez-Ferriols"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "P&#233;rez-Ferriols"
            "email" => array:1 [
              0 => "perez&#95;ampferr&#64;gva&#46;es"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital General Universitario de Valencia&#44; Valencia&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Proyecto dosis eritematosa m&#237;nima &#40;DEM&#41;&#58; en busca del consenso en la t&#233;cnica del fototest"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The examination of a patient who presents with photosensitivity requires us to obtain a targeted medical history by asking the right questions and to perform an appropriate physical examination complemented by tests&#44; such as skin biopsy&#44; laboratory workup&#44; and direct immunofluorescence&#44; as required&#44; all of which are available in most general dermatology departments&#46; These elements provide the necessary basis for reaching a diagnosis in a high percentage of cases&#46; However&#44; a complete photobiological study requires more specific tests that are available only in specialized photobiology departments that have the necessary equipment and medical personnel trained to perform&#44; read&#44; and interpret the tests&#46; One of the basic techniques used in such departments is phototesting&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Phototesting can be used to determine the patient&#39;s minimal erythema dose &#40;MED&#41;&#44; which is defined as the dose of UV-B radiation that produces perceptible erythema 24<span class="elsevierStyleHsp" style=""></span>hours after administration&#46; It can also be used to determine abnormal reactions to UV-A radiation and visible light&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Though this procedure may at first seem simple&#44; it is complicated by a number of factors and the resulting MED value will depend on the subjective interpretation of the observer&#44; the skin site tested&#44; the patient&#39;s age&#44; the ambient temperature&#44; the degree of pigmentation of the patient&#39;s skin&#44; and of course their phototype&#46; Furthermore&#44; individuals with the same phototype can have different MEDs&#44; possibly because of the factors mentioned above&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">All these factors make it difficult to determine whether a patient presenting with photosensitivity has a reduced MED if we have no baseline data&#46; Moreover&#44; it has been observed that in up to 68&#37; of patients with photosensitivity the MED value is normal&#44; a finding indicating that this figure is of only relative value<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in prevalent dermatoses such as polymorphic light eruption and the less frequent photodermatitis and actinic prurigo&#46; In other photodermatoses&#44; such as solar urticaria&#44; the phototest usually becomes a veritable challenge test and we take an immediate reading to determine the minimal urticarial dose at each wavelength tested&#46; In chronic actinic dermatitis&#44; a decrease in the MED is a diagnostic criterion and its detection is therefore a great aid to diagnosis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">As if the interpretation of these results was not already sufficiently problematic&#44; those of us who attend meetings of the Spanish Photobiology Group have been puzzled and concerned by apparently glaring inconsistencies in the MED values obtained using phototesting reported in some presentations&#59; in some cases&#44; MED values have even been stated in terms of time &#40;seconds&#41; rather than doses&#46; Furthermore&#44; even when MED values have been given in units of energy per unit area &#40;mJ&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#44; the results reported by different working groups for individuals who theoretically have the same phototype have varied by as much as 50 to 70<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#46; These findings were incomprehensible because the light sources used in the majority of departments are similar&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In view of this situation and the lack of any consensus on standards in either the Spanish or English literature&#44; in 2010 the Spanish Photobiology Group recognized the need to undertake a joint project to unify standards&#46; The Spanish Photobiology Group is a multidisciplinary working group within the Spanish Academy of Dermatology and Venereology&#46; In this group dermatologists have worked side by side with biologists&#44; physicists&#44; chemists&#44; pharmacists&#44; meteorologists&#44; and astronomers for almost 25 years&#46; This collaboration allows the same problem to be approached from different standpoints by experts in each field&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The first step in our project was to collect information on the methods used to perform phototesting in each photobiology department&#46; A total of 9 Spanish hospitals participated in the project and physicists&#44; meteorologists&#44; and biologists also provided their expertise&#44; time&#44; and equipment&#46; Together we achieved an enhanced understanding of our light sources&#44; which are mainly xenon arc solar simulators and broadband UV-B fluorescent lamps&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We calibrated all the equipment at practically the same time in all the participating institutions&#44; a measure that some members of the group had been requesting for years&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Solar simulators in particular are simple but highly sensitive devices&#44; and even the handling required to perform the test can alter the arrangement of the mirror systems that direct the light beam&#46; Each light source was characterized spectrally using a spectroradiometer to determine the erythemal irradiance &#40;ability to produce erythema&#41; of each wavelength&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This procedure revealed the cause of the discrepancies in the radiation doses used by the groups&#44; making everyone aware of the erythemal weighting function&#44; a function used by physicists and biologists but little known to dermatologists which takes into account the ability to produce erythema of each wavelength of the light source&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The group defined a methodology for phototesting&#44; which specified the need to identify the ideal anatomical region&#44; the diameter of each irradiated area&#44; the distance between the irradiated areas&#44; and the reading times&#46; On the basis of previous experience&#44; different series of exploratory doses were specified for departments using solar simulators and for departments using broadband UVB lamps&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The participants in the project performed phototesting on a healthy Spanish population&#46; The primary aim was to identify the MED thresholds for the main skin phototypes and to standardize the doses and units of measurement used by all centers performing phototesting&#46; In addition&#44; we tried to establish the cutoff points for each group below which a MED value would indicate photosensitivity&#44; especially for skin phototypes II and III&#44; the largest groups in the study population and probably those most representative of the Spanish population as a whole&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">This project also opened discussion on the usefulness of this procedure in dermatoses such as polymorphic light eruption and actinic prurigo&#44; in view of the high percentage of normal results reported in the literature and by those who perform the test regularly&#46; In these settings&#44; it may be recommendable to perform challenge tests &#40;repeated application of various MEDs at the same location over several days&#41; although these tests are not always relevant and are time-consuming for patients and medical personnel&#46; Furthermore&#44; their usefulness in this setting has been seriously questioned by Spanish photobiologists&#46; In my opinion&#44; for the diagnosis of these diseases it would be more appropriate to obtain a biopsy of the skin lesions and&#44; in the case of polymorphic light eruption&#44; to perform direct immunofluorescence and determine circulating autoantibody titers to rule out lupus erythematosus&#46; However&#44; these diagnostic procedures would not be appropriate in solar urticaria and chronic actinic dermatitis&#44; or in certain cases of systemic drug-induced photosensitivity&#46; In the cases of drug-induced photosensitivity&#44; measurement of the decrease in MED values following administration of the suspected drug would also be very helpful in diagnosis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The results of the project&#44; soon to be published in this journal&#44; will provide a working methodology for all those who perform phototests and of particular value to novices in the technique&#46; The present project&#44; together with the publication of a study that will lay the foundations for the new European photoallergen battery&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> to which Spain has made a large contribution&#44; provides clear evidence of the steady progress toward standardization being made by clinical photobiology&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; P&#233;rez-Ferriols A&#46; Proyecto dosis eritematosa m&#237;nima &#40;DEM&#41;&#58; en busca del consenso en la t&#233;cnica del fototest&#46; Actas Dermosifiliogr&#46; 2013&#59;104&#58;541&#8211;2&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultraviolet radiation-induced erytema in human skin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Graham"
                            1 => "Harrison"
                            2 => "A&#46;R&#46; Young"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Methods"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "paginaInicial" => "14"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12231183"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normal minimal erythema dose responses in patients with suspected photosensitivity disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Keena"
                            1 => "T&#46; Que"
                            2 => "J&#46; Brauer"
                            3 => "N&#46; Soter"
                            4 => "D&#46; Cohen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Photoderm Photimmunol Photomed"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "320"
                        "paginaFinal" => "321"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Algunas evidencias cl&#237;nicas sobre la necesidad del calibrado de simuladores solares usados en dermatolog&#237;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Mart&#237;nez Lozano"
                            1 => "M&#46;P&#46; Utrillas Esteban"
                            2 => "R&#46; Pedr&#243;s Esteban"
                            3 => "F&#46; Tena Sang&#252;esa"
                            4 => "J&#46; de la Cuadra Oyanguren"
                            5 => "A&#46; P&#233;rez Ferriols"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr&#46;"
                        "fecha" => "2001"
                        "volumen" => "92"
                        "paginaInicial" => "444"
                        "paginaFinal" => "451"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A European multicentre photopatch test study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "The European Multicentre Photopatch Test Study &#40;EMCPPTS&#41; Taskforce"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2012.10857.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br&#46; J&#46; Dermatol&#46;"
                        "fecha" => "2012"
                        "volumen" => "166"
                        "paginaInicial" => "1002"
                        "paginaFinal" => "1009"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22283432"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010400000007/v1_201308270818/S1578219013001418/v1_201308270818/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6152"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Opinion Article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000007/v1_201308270818/S1578219013001418/v1_201308270818/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001418?idApp=UINPBA000044"
]
Article information
ISSN: 15782190
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 36 11 47
2024 October 417 57 474
2024 September 282 29 311
2024 August 318 64 382
2024 July 284 39 323
2024 June 241 51 292
2024 May 219 46 265
2024 April 189 35 224
2024 March 189 34 223
2024 February 211 33 244
2024 January 287 48 335
2023 December 196 26 222
2023 November 187 41 228
2023 October 210 41 251
2023 September 161 41 202
2023 August 133 37 170
2023 July 124 53 177
2023 June 119 32 151
2023 May 164 32 196
2023 April 128 25 153
2023 March 94 27 121
2023 February 68 32 100
2023 January 53 33 86
2022 December 55 40 95
2022 November 31 28 59
2022 October 30 22 52
2022 September 26 34 60
2022 August 51 36 87
2022 July 41 36 77
2022 June 35 22 57
2022 May 112 43 155
2022 April 91 45 136
2022 March 108 71 179
2022 February 84 28 112
2022 January 113 48 161
2021 December 68 45 113
2021 November 56 40 96
2021 October 96 70 166
2021 September 64 45 109
2021 August 95 27 122
2021 July 48 29 77
2021 June 50 26 76
2021 May 55 46 101
2021 April 99 69 168
2021 March 55 27 82
2021 February 51 31 82
2021 January 35 15 50
2020 December 43 15 58
2020 November 40 16 56
2020 October 48 29 77
2020 September 44 17 61
2020 August 28 25 53
2020 July 28 27 55
2020 June 35 30 65
2020 May 23 16 39
2020 April 31 22 53
2020 March 407 18 425
2020 February 5 2 7
2020 January 4 0 4
2019 December 8 2 10
2019 November 4 0 4
2019 October 0 1 1
2019 September 12 0 12
2019 August 4 0 4
2019 July 4 0 4
2019 June 6 2 8
2019 May 4 28 32
2019 April 2 3 5
2019 March 2 7 9
2019 February 2 0 2
2019 January 2 0 2
2018 December 1 0 1
2018 November 1 0 1
2018 October 4 0 4
2018 September 1 0 1
2018 June 0 1 1
2018 May 0 7 7
2018 April 0 6 6
2018 March 2 4 6
2018 February 73 8 81
2018 January 67 7 74
2017 December 78 7 85
2017 November 109 18 127
2017 October 129 5 134
2017 September 97 18 115
2017 August 113 19 132
2017 July 110 9 119
2017 June 99 38 137
2017 May 88 21 109
2017 April 123 21 144
2017 March 88 24 112
2017 February 89 11 100
2017 January 77 6 83
2016 December 111 10 121
2016 November 128 14 142
2016 October 147 13 160
2016 September 208 16 224
2016 August 134 24 158
2016 July 81 6 87
2016 June 8 19 27
2016 May 9 9 18
2016 April 6 1 7
2016 March 6 19 25
2016 February 9 16 25
2016 January 7 1 8
2015 December 12 1 13
2015 November 6 2 8
2015 October 8 2 10
2015 September 4 1 5
2015 August 4 4 8
2015 July 37 6 43
2015 June 54 9 63
2015 May 45 27 72
2015 April 34 18 52
2015 March 37 18 55
2015 February 35 27 62
2015 January 33 9 42
2014 December 34 7 41
2014 November 27 10 37
2014 October 32 14 46
2014 September 30 9 39
2014 August 32 14 46
2014 July 18 10 28
2014 June 33 16 49
2014 May 24 18 42
2014 April 30 12 42
2014 March 35 19 54
2014 February 21 4 25
2014 January 20 16 36
2013 December 23 16 39
2013 November 13 9 22
2013 October 17 13 30
2013 September 22 6 28
Show all

Follow this link to access the full text of the article

Idiomas
Actas Dermo-Sifiliográficas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?