Original Article
Retrospective Study of the Clinical, Histologic, and Immunologic Features of Epidermolysis Bullosa Acquisita in 9 Patients
Estudio retrospectivo de las características clínicas, histológicas e inmunológicas en una serie de de 9 pacientes con epidermólisis ampollosa adquirida
A. Barreiro-Capurro, J.M. Mascaró-Galy, P. Iranzo
Corresponding author
Servicio de Dermatología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
Read
9013
Timeswas read the article
2455
Total PDF
6558
Total HTML
Share statistics
array:24 [ "pii" => "S1578219013002412" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.05.003" "estado" => "S300" "fechaPublicacion" => "2013-12-01" "aid" => "864" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2012" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2013;104:904-14" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3643 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 3002 "PDF" => 589 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731013002524" "issn" => "00017310" "doi" => "10.1016/j.ad.2013.05.005" "estado" => "S300" "fechaPublicacion" => "2013-12-01" "aid" => "864" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2013;104:904-14" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4280 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 3421 "PDF" => 858 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Estudio retrospectivo de las características clínicas, histológicas e inmunológicas en una serie de 9 pacientes con epidermólisis ampollosa adquirida" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "904" "paginaFinal" => "914" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Retrospective Study of the Clinical, Histologic, and Immunologic Features of Epidermolysis Bullosa Acquisita in 9 Patients" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figura 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 2532 "Ancho" => 1039 "Tamanyo" => 110885 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Inmunoblot con proteínas recombinantes (paciente 3). Se observa una banda de 145<span class="elsevierStyleHsp" style=""></span>kD (correspondiente a la región NC1 del colágeno <span class="elsevierStyleSmallCaps">vii</span>).</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">CN: control negativo; CP: control positivo; P: suero paciente.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Barreiro-Capurro, J.M. Mascaró-Galy, P. Iranzo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Barreiro-Capurro" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Mascaró-Galy" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Iranzo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219013002412" "doi" => "10.1016/j.adengl.2013.05.003" "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/S1578219013002412?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013002524?idApp=UINPBA000044" "url" => "/00017310/0000010400000010/v1_201311281152/S0001731013002524/v1_201311281152/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219013002424" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.09.024" "estado" => "S300" "fechaPublicacion" => "2013-12-01" "aid" => "738" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2013;104:915-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5640 "formatos" => array:3 [ "EPUB" => 69 "HTML" => 4406 "PDF" => 1165 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Erythema Nodosum Leprosum and Reversal Reaction in 2 Cases of Imported Leprosy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "915" "paginaFinal" => "919" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eritema nudoso leproso y reacción de reversión en 2 casos de lepra importada" ] ] "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" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 669 "Ancho" => 900 "Tamanyo" => 257951 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lymphocytic, neutrophilic, and histiocytic infiltrate in the deep dermis in a patient with erythema nodosum leprosum (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Pulido-Pérez, M.D. Mendoza-Cembranos, J.A. Avilés-Izquierdo, R. Suárez-Fernández" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Pulido-Pérez" ] 1 => array:2 [ "nombre" => "M.D." "apellidos" => "Mendoza-Cembranos" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Avilés-Izquierdo" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Suárez-Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012004553" "doi" => "10.1016/j.ad.2012.09.009" "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/S0001731012004553?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013002424?idApp=UINPBA000044" "url" => "/15782190/0000010400000010/v1_201311281142/S1578219013002424/v1_201311281142/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219013002539" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.04.019" "estado" => "S300" "fechaPublicacion" => "2013-12-01" "aid" => "862" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2013;104:897-903" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2213 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 1335 "PDF" => 830 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Mental Health Self-Assessment in Patients With Moderate to Severe Psoriasis: An Observational, Multicenter Study of 1164 Patients in Spain (The VACAP Study)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "897" "paginaFinal" => "903" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Autoevaluación de salud mental en pacientes con psoriasis moderada a grave: un estudio multicéntrico observacional de 1.164 pacientes en España (el estudio VACAP)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R.M. Pujol, L. Puig, E. Daudén, J.L. Sánchez-Carazo, J. Toribio, F. Vanaclocha, M. Yébenes, E. Sabater, M.A. Casado, M.T. Caloto, B. Aragón" "autores" => array:11 [ 0 => array:2 [ "nombre" => "R.M." "apellidos" => "Pujol" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Puig" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Daudén" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "Sánchez-Carazo" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Toribio" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "Vanaclocha" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Yébenes" ] 7 => array:2 [ "nombre" => "E." "apellidos" => "Sabater" ] 8 => array:2 [ "nombre" => "M.A." "apellidos" => "Casado" ] 9 => array:2 [ "nombre" => "M.T." "apellidos" => "Caloto" ] 10 => array:2 [ "nombre" => "B." "apellidos" => "Aragón" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S000173101300238X" "doi" => "10.1016/j.ad.2013.04.014" "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/S000173101300238X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013002539?idApp=UINPBA000044" "url" => "/15782190/0000010400000010/v1_201311281142/S1578219013002539/v1_201311281142/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Retrospective Study of the Clinical, Histologic, and Immunologic Features of Epidermolysis Bullosa Acquisita in 9 Patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "904" "paginaFinal" => "914" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Barreiro-Capurro, J.M. Mascaró-Galy, P. Iranzo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Barreiro-Capurro" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Mascaró-Galy" ] 2 => array:4 [ "nombre" => "P." "apellidos" => "Iranzo" "email" => array:2 [ 0 => "PIRANZO@clinic.ub.es" 1 => "piranzof@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio retrospectivo de las características clínicas, histológicas e inmunológicas en una serie de de 9 pacientes con epidermólisis ampollosa adquirida" ] ] "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" => 1099 "Ancho" => 1480 "Tamanyo" => 271510 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A, Inflammatory epidermolysis bullosa acquisita. B, Subepidermal blister. Hematoxylin-eosin, original magnification ×40. C, Significant inflammatory infiltrate with predominance of neutrophils and scant eosinophils. Hematoxylin-eosin, original magnification ×100.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Epidermolysis bullosa acquisita (EBA) is a chronic subepidermal bullous disease of the cutaneous and mucosal tissues.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> EBA was originally described by Roenigk and colleagues<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1971 as a mechanobullous disorder associated with skin fragility. Although similar to congenital epidermolysis bullosa, EBA appears in adults with no family history. In 1973 Kushniruk<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported that direct immunofluorescence (DIF) revealed immunoglobulin (Ig) G and C3 deposition in the basement membrane of tissue samples from patients with EBA. In 1981 Yaoita and colleagues<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> used immunoelectron microscopy techniques to demonstrate the location of deposits in the sublamina densa in EBA and in the lamina lucida in bullous pemphigoid. In 1984 Woodley and colleagues<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> identified a 290-kDa protein as the target antigen in EBA; this protein was later identified as type VII collagen.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> An inflammatory variant of this disorder was then described; clinical characteristics were similar to those of bullous pemphigoid and other pemphigoid subtypes, mimicking mucosal pemphigoid or Brunsting-Perry cicatricial pemphigoid.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> Features of both conditions may be present at once or the clinical picture may shift toward one or the other during the course of disease.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">EBA is an uncommon disease with an estimated incidence of 0.2 cases per million inhabitants.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> The low prevalence has meant that no racial predilection has been established, although black patients of African descent were reported to be overrepresented in one patient series<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and higher prevalence has also been described for Korean populations.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Age at onset is usually between 40 and 50 years, although EBA has been found in patients of advanced age and in children.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> Vertical transmission from a mother with EBA to an infant has also been reported.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The etiology is unknown but it seems clear that autoantibodies to type VII collagen play a role in the pathogenesis of this disease. The relevance of these antibodies has been demonstrated by the development of blisters in an infant as a result of the transfer of antibodies from maternal blood to the fetus.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Ex vivo evidence comes from the induction of dermal-epidermal separation, with neutrophil recruitment, in frozen sections of human skin exposed to sera from patients with EBA.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Experimental in vivo models of EBA have been based on passive immunization (transfer to mice of IgG antibodies to type VII human or rabbit collagen)<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> or active immunization (of certain mice strains with immunodominant fragments in the NC1 domain of type VII collagen).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The classic mechanobullous form of EBA is characterized histologically by the presence of subepidermal blisters with scant inflammatory infiltrate. Inflammatory EBA is marked by a more intense infiltrate containing neutrophils in abundance and occasionally eosinophils. DIF reveals linear, predominantly IgG deposition along the dermal-epidermal basement membrane. C3, IgA, or IgM deposition of variable intensity is observed in some cases.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,20</span></a> Indirect immunofluorescence (IIF) of sera from some patients may detect the presence of circulating IgG autoantibodies that target the dermal-epidermal basement membrane. It is possible to use different substrates, such as human skin or monkey esophageal tissue,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> but the best results are obtained using human skin separated in a 1.0-M sodium chloride (NaCl) solution. The use of salt-split skin enables detection of circulating IgG autoantibodies that bind to the dermal (base) side of the separation, a finding that distinguishes EBA from bullous pemphigoid, in which these autoantibodies bind to the epidermal (roof) side. Although this is a relatively simple way to differentiate these 2 diseases, it will not distinguish EBA from other autoimmune subepidermal bullous diseases with a dermal pattern, such as bullous systemic lupus erythematosus (BLSE) or various forms of pemphigoid associated with anti-laminin 332, anti-laminin γ1 or anti-laminin-p 105).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> When IIF is negative, DIF can be used after inducing separations in biopsy material (with the 1.0-M NaCl solution); alternatively, a suction-induced blister can be biopsied for DIF. DIF will also pinpoint the location of IgG deposits in the dermal portion of the separation in EBA. However, like IIF, this technique will not differentiate between EBA and other diseases with a dermal pattern.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The diagnostic value of the pattern of autoantibody deposition in the membrane has recently been described. When IgG deposits form above the sublamina densa (in bullous pemphigoid and anti-lamina 332 pemphigoid), an n-serrated pattern is typical; when deposits are in the sublamina densa (as in EBA), a u-serrated pattern forms; for this technique sections must be of less than 4<span class="elsevierStyleHsp" style=""></span>μm.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Immunoblotting of serum from patients with EBA using dermal extracts identifies protein bands of approximately 290 kDa and 145 kDa, corresponding to complete (dimeric) type VII collagen or one of its regions (monomeric). Most antigen epitopes of collagen VII are located in the NC1 domain (145 kDa). Therefore, recombinant NC1 protein produced in the laboratory can also be used in immunoblot analysis or in classic enzyme-linked immunosorbent assay (ELISA). ELISA using recombinant NC1 is considerably more sensitive and specific than IIF on a split-skin substrate or immunoblotting with dermal extracts; ELISA also quantifies autoantibodies.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> A recently desribed technique using complete type VII collagen (containing both the NC1 and NC2 domains) has been shown to be slightly more sensitive than the technique using only NC1.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Immunoelectron microscopy is the gold standard diagnostic method because it identifies the location of immunoglobulin deposition in the sublamina densa in EBA and in the lamina lucida and hemidesmosomes in bullous pemphigoid.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,20</span></a> However, this is a complex technique that is unavailable in many centers.</p><p id="par0035" class="elsevierStylePara elsevierViewall">EBA can be diagnosed with a fair degree of certainty by correlating clinical findings with the results of the various diagnostic tools. However, it cannot be distinguished from BSLE in this way, since pathogenic autoantibodies to type VII collagen are present in both diseases.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> For a diagnosis of BSLE, the American College of Rheumatology (ACR) criteria must be met. BSLE lesions are mainly located in skin areas exposed to sunlight, and this disease is less refractory to treatment than EBA.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Various therapies for EBA have been tried and have often proven ineffective; in any case, response is unpredictable. Few large patient series have been published and no randomized clinical trials have been performed because the disease is so rare.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,28</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">We analyzed the demographic, clinical, and immunopathologic characteristics of EBA as well as response to therapy in a series of patients diagnosed between 1985 and 2011 in our hospital.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients and Methods</span><p id="par0050" class="elsevierStylePara elsevierViewall">This retrospective study included patients diagnosed with EBA in Hospital Clínic de Barcelona between 1985 and 2011. Diagnosis was based on clinical, histologic, and immunopathologic evidence. We analyzed all demographic, clinical, immunopathologic, and therapeutic data on record.</p><p id="par0055" class="elsevierStylePara elsevierViewall">For IIF studies we used salt-split human skin prepared conventionally by incubation in a 1.0<span class="elsevierStyleHsp" style=""></span>M NaCl solution; patient serum samples for studies were obtained during the active phase of disease.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> For DIF we used the method described by Gammon and colleagues.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Immunoblotting was performed using dermal extracts and, in some cases, recombinant proteins of the NC1 domain of type VII collagen were used. ELISA was performed on domain-specific recombinant proteins (His-hCVII-NC1 and NC2-His-hCVII-NC1 NC2-H) of type VII collagen, as described elsewhere.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">We identified 9 patients diagnosed with EBA between 1985 and 2011. The mean age was 37 years; 3 were men and 6 women (male:female ratio, 1:2). The median time between onset and diagnosis was 7 months (range, 1–72 months).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Most of the patients (6 out of 9) presented with the inflammatory form (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The classic mechanobullous form (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) was seen in patients of more advanced age: all patients with this form were over 72 years old. In 1 patient (Case 5, <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), the clinical phenotype changed from bullous pemphigoid to Brunsting-Perry pemphigoid. Disease was confined to the skin in only 2 patients. All of the 7 patients with mucosal involvement had oral lesions; additionally, 2 had lesions on the genitals, 2 had conjunctival involvement, and 1 had lesions on the pharynx, larynx and esophagus.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Malignant disease was a frequent association, with 5 tumors in 3 patients. Two tumors were in the lung, 1 was on the cervix, 1 in the breast, and 1 in the skin (melanoma). Other associations were inflammatory bowel disease (1 case of Crohn disease and 1 of ulcerative colitis) and autoimmune diseases or a finding of circulating antibodies (1 hemolytic anemia, 1 optic neuritis, 1 thyroiditis, 4 positive for antinuclear antibodies [ANA]) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Histology showed a subepidermal blister with scant inflammatory infiltrate for all 3 patients with classic EBA. In the 6 patients with inflammatory EBA, histology detected an inflammatory infiltrate with abundant neutrophils and eosinophils, and occasional microabscesses in the papillary dermis. Eosinophilic spongiosis was observed in 2 cases. DIF consistently showed linear IgG and C3 deposits of variable intensity along the basement membrane(<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Other conjugates were detected in 5 patients (56%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). IIF was performed with human salt-split skin and the serum samples from 8 patients; in 6 of these patients (75%) the result was positive and a dermal pattern was detected (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). For 1 patient (case 6, <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), IIF performed in another center only detected the presence of ANA; serum was not available to us for IIF in salt-split human skin. Results of DIF on salt-split skin showed an exclusively dermal IgG deposition pattern for all 6 patients in whom this test was performed; this group included 2 patients with negative IIF results and a patient for whom IIF was not performed.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Type VII collagen ELISA was performed in 5 cases and was positive in 2 (40%). Immunoblot analysis was performed in 6 cases and was positive in 5 (83%) (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). These results are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. ANA were detected in 4 patients (44%). In 1 case (patient 6, <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), this was an isolated finding. In 2 other cases (patients 3 and 7, <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) autoimmune diseases were also found. Although patient 8 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) was positive for ANA and anti-DNA, the ACR criteria for a diagnosis of BSLE were never met at any time during the course of disease. This patient was unresponsive to high doses of corticosteroids and dapsone but showed a good response to intravenous immunoglobulin (IVIG) therapy and colchicine. These outcomes suggested a diagnosis of EBA rather than BSLE even though the 2 processes have similar immunologic features and overlap to a certain extent.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">After diagnosis, a variety of treatments were tried; response was variable in most patients and disease was difficult to control in 2 cases (patients 3 and 5, <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Patient 3 started treatment with prednisone at a daily dose of 1<span class="elsevierStyleHsp" style=""></span>mg/kg, achieving partial response. Colchicine at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>h was added, followed by dapsone (100<span class="elsevierStyleHsp" style=""></span>mg/d), to little effect. High-dose IVIG therapy (2<span class="elsevierStyleHsp" style=""></span>g/kg) was therefore started. There was still no response, but after prednisone and colchicine were added to the regimen, partial response was finally achieved. During the course of disease, pulmonary adenocarcinoma was detected; metastasis developed and the patient died. The case of patient 5 was the most refractory to therapy. Various treatments were tried and withdrawn, either because of adverse events or lack of response. In December 2007, rituximab was started (375<span class="elsevierStyleHsp" style=""></span>mg/m<span class="elsevierStyleSup">2</span>/wk for 4 weeks). There was good response to this regimen in the skin, but gingival erosion remained a problem. At the time of writing, the patient was in complete remission on low-dose corticosteroids, dapsone, and colchicine. We emphasize the excellent response to IVIG therapy in a patient with the classic form of EBA (patient 1, <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) because lesions had been refractory to all the treatments that had been tried previously.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">EBA is an uncommon disease that mainly affects adults.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> The median age at diagnosis in our series was 37 years; women predominated, as in the 4 previously published studies.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29–32</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The classic mechanobullous form of EBA is the one that was first reported. This form has quite characteristic clinical features that facilitate diagnosis, undoubtedly explaining why most of the initial publications were about this phenotype. Since the inflammatory variety was described, more cases of this form have emerged. It is possible that greater understanding of EBA and appropriate use of the diagnostic techniques now available have enabled the diagnosis of cases that might previously have been thought to be bullous pemphigoid. The inflammatory form was more frequent in our series, as in other recently published ones. However the classic form predominated in our older patients, an observation that was not described in other series.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29–32</span></a> We cannot explain this finding and the small number of patients precludes drawing conclusions. It is well known that EBA is often found in association with other diseases. The most clearly established association is probably with inflammatory bowel disease, particularly Crohn disease.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> The presence of type VII collagen in the intestinal epithelium and the phenomenon of epitope spreading could explain this association; this hypothesis is supported by the presence of circulating antibodies that target this collagen in approximately 68% of patients with Crohn disease even when no skin signs are present.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33,34</span></a> In our series the incidence of tumors was higher in association with inflammatory bowel disease. Single cases of EBA associated with tumors have been reported, but the association has not been reported in any patient series until now. The course of disease in our patients did not seem to suggest a paraneoplastic process. In fact, the 3 tumors that had been diagnosed before the onset of EBA were in remission. In patient 3, diagnosis was delayed 72 months from onset and the tumors were detected at the same time; she did not receive immunosuppressants that might have triggered development of the tumor. In patient 2, the tumor presented after complete remission of EBA, which had been treated only with colchicine.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The degree of clinical inflammation correlated with the intensity of the inflammatory infiltrate, consistent with the literature on histologic findings in this disease. DIF did not allow us to differentiate EBA from bullous pemphigoid, even though we often observed that IgG deposits were more intense than C3 deposits in our EBA patients (in contrast with the more intense C3 deposition reported in pemphigoid<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>). The diagnostic method with the highest sensitivity was DIF with salt-split skin, which showed a dermal pattern in all cases where it was used. IIF with salt-split skin was negative in only 2 patients. The immune-deposit patterns revealed by DIF—either n-serrated or u-serrated—could not be assessed in our series, possibly because of technical problems related to the thickness of sections. We must point out that the results of the tests done in patient 5 did not lead to a definitive diagnosis of EBA. We cannot rule out that this slowly progressing case, which was refractory to treatment, was not IgA-mediated EBA because the appropriate ELISA was not done for this patient, who had associated Crohn disease and mucosal involvement and was negative for anti-BP 180 antibody. IgG deposition in the basement membrane, however, was much more intense than either IgA or C3 deposition.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Response to therapy was highly variable and not always satisfactory. We underline the excellent results obtained with IVIG infusion in a woman with the classic form of EBA who had not responded to several previous treatments (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The approach to EBA treatment we would suggest based on our experience would be to start prednisone (or an equivalent) at 0.5<span class="elsevierStyleHsp" style=""></span>mg/kg in association with colchicine (1–2<span class="elsevierStyleHsp" style=""></span>mg/d) and/or dapsone (25–100<span class="elsevierStyleHsp" style=""></span>mg/d). If the patient responds well enough to allow the prednisone dose to be tapered to 5<span class="elsevierStyleHsp" style=""></span>mg (or discontinued altogether), the corticosteroid therapy can be maintained. If the prednisone dose cannot be reduced (despite the addition of up to 100<span class="elsevierStyleHsp" style=""></span>mg of dapsone and 2<span class="elsevierStyleHsp" style=""></span>mg of colchicine) we suggest adding IVIG therapy. Rituximab currently seems to be more effective at a lower cost, and this drug could be a good choice in cases that are refractory to other treatments. However, our experience with rituximab in EBA is limited to a single patient.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In summary, we present the first Spanish series of EBA patients. Consistent with the only other 4 series published<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29–32</span></a> (analyzing 38, 30, 14, and 12 patients, respectively), we found that inflammatory EBA predominated. In EBA, clinical suspicion must be high and optimal use of available diagnostic tools will be necessary for reaching a firm diagnosis. Lehman and colleagues<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> proposed a diagnostic algorithm for autoimmune bullous diseases that took into consideration the cost of the various tests so that they can be used rationally. After diagnosis, the extent of disease and the possibility of associated conditions must be carefully assessed, and appropriate treatment should be started so that involvement of the eye and mucosae of the respiratory and digestive tracts can be prevented. Because this disease is highly variable in presentation, it is difficult to evaluate response to a particular drug.</p><p id="par0115" class="elsevierStylePara elsevierViewall">This retrospective study included a small number of patients. Prospective multicenter studies are needed to improve our understanding of the mechanisms involved in EBA, to assess the efficacy of the drug treatments available, and to provide a basis for tailoring treatment.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their hospitals concerning the publication of patient data, and that all the patients included in this study were appropriately informed and gave their written informed consent.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of Interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres295307" "titulo" => array:6 [ 0 => "Abstract" 1 => "Background" 2 => "Objective" 3 => "Materials and methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec279228" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres295306" "titulo" => array:6 [ 0 => "Resumen" 1 => "Introducción" 2 => "Objetivo" 3 => "Material y métodos" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec279227" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of Interest" ] 10 => array:2 [ "identificador" => "xack69005" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec279228" "palabras" => array:2 [ 0 => "Epidermolysis bullosa acquisita" 1 => "Autoimmune subepidermal bullous disease" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec279227" "palabras" => array:2 [ 0 => "Epidermólisis ampollosa adquirida" 1 => "Enfermedad ampollosa subepidérmica autoinmune" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Epidermolysis bullosa acquisita (EBA) is an autoimmune subepidermal blistering disease caused by autoantibodies to type VII collagen. The clinical presentation is variable, with skin and mucosal lesions that can cause significant dysfunction. Different treatment options exist, but the results are often unsatisfactory.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To review all the cases of epidermolysis bullosa acquisita (EBA) diagnosed at our hospital over a 26-year period.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective review of the clinical, histologic, and immunologic features of EBA in 9 patients.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mean age at presentation was 37 years and 66.67% of the patients were women. EBA occurred in association with malignant tumors, inflammatory bowel disease, and autoimmune disorders. The most common variant was inflammatory EBA (6 of the 9 cases). In all 9 patients, histology revealed a subepidermal blister and direct immunofluorescence showed linear deposits of immunoglobulin G and C3 in the basement membrane zone. Indirect immunofluorescence performed on salt-split skin substrate was positive in 6 patients and showed a dermal pattern in all cases. Five patients were tested for autoantibodies to type VII collagen using enzyme-linked immunosorbent assay, with positive results in 2 cases. Immunoblotting using recombinant noncollagenous domains (NC1) of type VII collagen was positive in all 6 cases in which it was performed. Response to treatment was variable.</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">EBA is a rare disease with a variable clinical presentation that can be confused with that of other subepidermal blistering diseases. Correct diagnosis requires a high level of clinical suspicion and the use of all available diagnostic tests. Thorough evaluation of cutaneous and mucosal involvement and prompt initiation of appropriate treatment will ensure the detection and prevention of dysfunction and treatment-related complications.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La epidermolisis ampollosa adquirida es una enfermedad ampollosa subepidérmica autoinmune causada por autoanticuerpos contra el colágeno VII. Su clínica es heterogénea con afectación de piel y mucosas pudiendo generar secuelas invalidantes. Existen diversas opciones terapéuticas frecuentemente insatisfactorias.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Revisar los casos de epidermolisis ampollosa adquirida diagnosticados durante un periodo de 26 años.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de las características clínicas e inmunopatológicas de 9 pacientes con dicho diagnóstico</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La mediana de edad de presentación fue de 37 años, el 66.67% de pacientes fueron mujeres. Asociaciones: neoplasias malignas, enfermedad inflamatoria intestinal y procesos autoinmunes. La variante inflamatoria fue la más frecuente (6/9). La histología mostró constantemente una ampolla subepidérmica y la inmunofluorescencia directa la presencia de depósitos lineales de IgG y C3 en membrana basal. La inmunofluorescencia indirecta fue positiva en 6 pacientes, mostrando en todos ellos un patrón dérmico en piel separada. En 5 pacientes se determinaron los anticuerpos contra el colágeno VII por Enzyme-Linked Immuno Sorbent Assay de los cuales 2 fueron positivos, e Inmunoblot con NC1 recombinante en 6 casos, positivo en todos ellos. La respuesta terapéutica fue variable.</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se trata de una enfermedad rara, de clínica heterogénea que puede inducir a confusión con otras enfermedades ampollosas subepidérmicas. Se requiere un alto índice de sospecha y el empleo de todos los métodos disponibles para establecer su diagnóstico. La correcta evaluación de la afectación cutáneo-mucosa y la instauración precoz de la terapéutica adecuada permitirá la detección de sus secuelas y de las complicaciones del tratamiento.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Barreiro-Capurro A, Mascaró-Galy JM, Iranzo P. Estudio retrospectivo de las características clínicas, histológicas e inmunológicas en una serie de de 9 pacientes con epidermólisis ampollosa adquirida. Actas Dermosifiliogr. 2013;104:904–914.</p>" ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1094 "Ancho" => 1464 "Tamanyo" => 232159 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A, Classic epidermolysis bullosa acquisita, showing scarring in areas of friction and milium cysts. B, Subepidermal blister. Hematoxylin-eosin, original magnification ×40. C, Scant inflammatory infiltrate. Hematoxylin-eosin, original magnification ×100.</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" => 1099 "Ancho" => 1480 "Tamanyo" => 271510 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A, Inflammatory epidermolysis bullosa acquisita. B, Subepidermal blister. Hematoxylin-eosin, original magnification ×40. C, Significant inflammatory infiltrate with predominance of neutrophils and scant eosinophils. Hematoxylin-eosin, original magnification ×100.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 614 "Ancho" => 1500 "Tamanyo" => 71191 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Direct immunofluorescence showing the characteristic epidermolysis bullosa acquisita pattern of deposition along the dermal-epidermal junction. A, Intense linear immunoglobulin G deposition. B, Slight C3 deposition. Original magnification ×200.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 830 "Ancho" => 950 "Tamanyo" => 154666 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Indirect immunofluorescence using 1.0<span class="elsevierStyleHsp" style=""></span>M sodium chloride-separated skin. Antibodies are targeting the dermal side (floor) of the blister. Original magnification ×200.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1520 "Ancho" => 528 "Tamanyo" => 68586 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Immunoblot of recombinant proteins (patient 3). The 145-kDa band corresponds to the NC1 domain of type VII collagen.</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">NC refers to negative control; PC, positive control; P, patient's serum.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ABBREVIATIONS: ANA, antinuclear antibodies; COPD, chronic obstructive pulmonary disease; ELISA, ezyme-linked immunosorbent assay; HCV, hepatitis C virus; Ig, immunoglobulin; NIDDM, non-insulin-dependent diabetes mellitus; NP, not performed.</p>" "tablatextoimagen" => array:2 [ 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">Patient No. \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">Sex/Age at Diagnosis, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset to Diagnosis, mo \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 " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Medical History</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">Phenotype \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">Mucosal Involvement \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">Histology \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-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Tumor \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">Autoimmune Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Inflammatory Bowel Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Other \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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">Woman/77 \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">24 \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">No \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">No \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">No \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">NIDDM, hypertension, dyslipidemia \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">Noninflammatory \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">Oral \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">Subepidermal blister with scant inflammatory response \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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">Man<span class="elsevierStyleSmallCaps">/74</span> \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">12 \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">Bronchial adenocarcinoma \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">No \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">No \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">NIDDM, COPD, thalassemia, cirrhosis of the liver due to HCV infection, IgG-lambda monoclonal gammopathy \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">Noninflammatory \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">No \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">Subepidermal blister with scant inflammatory response \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \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">Woman/37 \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">72 \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">Carcinoma of the cervix, pulmonary adenocarcinoma \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">Coombs<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>hemolytic anemia; ANA, 1:160; anti-DNA, 22 \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">No \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">No \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 \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">Oral, genital, pharyngeal, laryngeal \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">Subepidermal blister with abundant neutrophils, eosinophils, and evidence of leukocytoclasia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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">Man<span class="elsevierStyleSmallCaps">/34</span> \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">No \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">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ulcerative colitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \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 \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">No \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">Eosinophilic spongiosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \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">Man<span class="elsevierStyleSmallCaps">/32</span> \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">60 \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">No \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">Autoimmune thyroiditis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Crohn disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \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 \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">Oral, conjunctival \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">Subepidermal blister with abundant neutrophils and eosinophils; formation of papillary microabscesses \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \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">Woman/26 \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">No \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">ANA 1:320, speckled \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">No \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">Asthma \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 \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">Oral \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">Subepidermal blister with abundant neutrophils and eosinophils \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \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">Woman/64 \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 \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">Melanoma, breast adenocarcinoma, eccrine poroma \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">ANA 1:160, autoimmune optic neuritis \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">No \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">Osteoporosis, COPD, allergic rhinitis \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 \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">Oral, genital \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">Eosinophilic spongiosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \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">Woman/19 \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">No \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">ANA 1:1280, weak anti-ADN, anti-Ro+ \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">No \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">Arthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inflammatory \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">Oral, esophageal \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">Subepidermal blister with abundant neutrophils \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">9 \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">Woman/72 \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">No \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">No \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">No \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">Toxic hepatitis \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">Noninflammatory \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">Oral, conjunctival \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">Subepidermal blister with scant inflammatory response \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab430509.png" ] ] 1 => 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">Patient No. \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 " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Immunofluorescence</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">ELISA, Type VII Collagen \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">Immunoblotting \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-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">DIF \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">DIF, Salt-Split Human Skin \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">IIF, Salt-Split Human Skin \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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">IgG, C3 \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">NP \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">Dermal, 1:320 \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">NP \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">Laminin 332 (IgG4) negative; type VII collagen (NC1 for IgG1, IgG3, IgG4) positive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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">IgG, IgM, C3 \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">Dermal \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">Negative \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">Negative \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">Anti-laminin 332 (IgG4) negative; type VII collagen (NC1 for IgG1, IgG3, IgG4) positive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \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">IgG, IgA, C3 \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">NP \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">Dermal, IgA, and IgG 1:320 \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">Positive \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">NC1: IgG4 ++, IgA positive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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">IgG, C3 \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">Dermal \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">Negative \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">NP \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">Laminin 332 (IgG4) negative; collagen VII (NC1 for IgG1, IgG3, IgG4) positive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \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">IgG, IgA, C3 \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">Dermal \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">Dermal, 1:160 \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">Negative \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">Laminin 332 (IgG4) negative; collagen VII (NC1 for IgG1, IgG3, IgG4) positive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \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">IgG, IgA, C3 \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">Dermal \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">NP \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">NP \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">NP \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \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">IgG, C3 \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">Dermal \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">Dermal, 1:20 \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">Positive \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">NP \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \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">IgG, IgM, IgA, C3, fibrinogen \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">Dermal \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">Dermal, 1:20 (ANA dermal-epidermal) \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">Negative \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">NC1: IgG1-IgG4-IgA type VII collagen positive \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">9 \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">IgG, C3 \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">NP \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">Dermal \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">NP \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">NP \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab430508.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Epidermolysis Bullosa Acquisita: Clinical and Immunopathologic Characteristics.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">ABBREVIATIONS: AZA, azathioprine; CR, complete response; CyA, ciclosporin; IVIG, intravenous immunoglobulins; MTP, methylprednisolone; MTX, methotrexate; PDN, prednisone; PR, partial response; PTE, pulmonary thromboembolism.</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">Patient No. \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">Corticosteroids \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">Colchicine \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">Dapsone \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">IVIG (2<span class="elsevierStyleHsp" style=""></span>g/kg) \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">Infliximab \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">AZA \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">MTX \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">CyA \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">Rituximab \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">Response \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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">PDN 30<span class="elsevierStyleHsp" style=""></span>mg/no response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not tolerated \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">No response \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">CR \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">No \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">No \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">No \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">No \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">No \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">CR without treatment<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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">No \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<span class="elsevierStyleHsp" style=""></span>mg, CR \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">No \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">No \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">No \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">No \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">No \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">No \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">No \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">CR without treatment<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \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">PDN 50<span class="elsevierStyleHsp" style=""></span>mg/PR \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<span class="elsevierStyleHsp" style=""></span>mg, PR \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">100<span class="elsevierStyleHsp" style=""></span>mg, PR \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">PR (plus PDN and colchicine) \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">No \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">No \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">No \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">No \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">No \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">PR with minimal treatment<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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">PDN 30<span class="elsevierStyleHsp" style=""></span>mg/PR \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">No \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">100<span class="elsevierStyleHsp" style=""></span>mg, CR \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">No \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">No \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">No \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">No \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">No \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">No \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">CR with treatment<a class="elsevierStyleCrossRef" href="#tbl2fn3"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \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">PDN 30<span class="elsevierStyleHsp" style=""></span>mg/no response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not tolerated \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">100<span class="elsevierStyleHsp" style=""></span>mg, methemoglobinemia \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">PR \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">PR \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">No response \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">No response \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">No \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">PR \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">CR with treatment<a class="elsevierStyleCrossRef" href="#tbl2fn3"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \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">PDN 15<span class="elsevierStyleHsp" style=""></span>mg, deflazacort 60<span class="elsevierStyleHsp" style=""></span>mg/PR \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">No \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">100<span class="elsevierStyleHsp" style=""></span>mg, CR \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">No \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">No \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">No \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">No \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">No \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">No \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">CR without treatment<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \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">PDN 25<span class="elsevierStyleHsp" style=""></span>mg/CR \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">No \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<span class="elsevierStyleHsp" style=""></span>mg, CR \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">No \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">No \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">No \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">No \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">No \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">No \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">CR with treatment<a class="elsevierStyleCrossRef" href="#tbl2fn3"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \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">PDN 60<span class="elsevierStyleHsp" style=""></span>mg/PR \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<span class="elsevierStyleHsp" style=""></span>mg, CR \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">150<span class="elsevierStyleHsp" style=""></span>mg, no response \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">CR \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">No \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">No \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">No \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">No \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">No \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">CR with treatment<a class="elsevierStyleCrossRef" href="#tbl2fn3"><span class="elsevierStyleSup">c</span></a> \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">9 \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">MTP 60<span class="elsevierStyleHsp" style=""></span>mg, PDN 10<span class="elsevierStyleHsp" style=""></span>mg/no response \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">No \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">No \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">No \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">No \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">No response \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">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not evaluable (exitus) \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">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not evaluable (exitus due to PTE) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab430510.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">CR without treatment refers to the resolution of lesions within 2 mo.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">PR with minimal treatment refers to new transient lesions that are cured within 1 wk in a patient undergoing minimal treatment.</p>" ] 2 => array:3 [ "identificador" => "tbl2fn3" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">CR with treatment refers to the resolution of lesions with minimal treatment (equal to or equivalent to 8<span class="elsevierStyleHsp" style=""></span>mg/d of methylprednisolone with or without dapsone or colchicine for at least 2 mo.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Treatment and Response.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa acquisita. Report of three cases and review of all published cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.H. Roenigk Jr." 1 => "J.G. Ryan" 2 => "W.F. Bergfeld" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1971" "volumen" => "103" "paginaInicial" => "1" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4321800" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa acquisita: Update and review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Hallel-Halevy" 1 => "C. Nadelman" 2 => "M. Chen" 3 => "D. Woodley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2001" "volumen" => "19" "paginaInicial" => "712" "paginaFinal" => "718" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11705680" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa acquisita" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Gupta" 1 => "D. Woodley" 2 => "M. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2011.03.011" "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "60" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22137228" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The immunopathology of epidermolysis bullosa acquisita" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W. Kushniruk" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Can Med Assoc J" "fecha" => "1973" "volumen" => "108" "paginaInicial" => "1143" "paginaFinal" => "1146" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4574408" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028202029667" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa acquisita: Ultrastructural and immunological studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Yaoita" 1 => "A. Briggaman" 2 => "T.J. Lawley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "1981" "volumen" => "76" "paginaInicial" => "288" "paginaFinal" => "292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7009764" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of the skin basement-membrane autoantigen in epidermolysis bullosa acquisita" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.T. Woodley" 1 => "R.A. Briggaman" 2 => "E.J. O’Keefe" 3 => "A.O. Inman" 4 => "L.L. Queen" 5 => "W.R. Gammon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198404193101602" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1984" "volumen" => "310" "paginaInicial" => "1007" "paginaFinal" => "1015" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6369131" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidermolysis bullosa acquisita antigen is the globular carboxyl terminus of type VII procollagen" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.T. Woodley" 1 => "R.E. Burgeson" 2 => "G. Lunstrum" 3 => "L. Bruckner-Tuderman" 4 => "M.J. Reese" 5 => "R.A. Briggaman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1172/JCI113373" "Revista" => array:6 [ "tituloSerie" => "J Clin Invest" "fecha" => "1988" "volumen" => "81" "paginaInicial" => "683" "paginaFinal" => "687" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3278005" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa—acquisita–a pemphigoid-like disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.R. Gammon" 1 => "R.A. Briggaman" 2 => "D.T. Woodley" 3 => "P.W. Heald" 4 => "C.E. Wheeler Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1984" "paginaInicial" => "820" "paginaFinal" => "832" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa acquisita presenting as an inflammatory bullous disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W.R. Gammon" 1 => "R.A. Briggaman" 2 => "C.E. Wheeler Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1982" "volumen" => "7" "paginaInicial" => "382" "paginaFinal" => "387" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6752224" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired epidermolysis bullosa with the clinical feature of Brunsting-Perry cicatricial bullous pemphigoid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Kurzhals" 1 => "W. Stolz" 2 => "M. Meurer" 3 => "J. Kunze" 4 => "O. Braun-Falco" 5 => "T. Krieg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1991" "volumen" => "127" "paginaInicial" => "391" "paginaFinal" => "395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1998371" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa acquisita with combined features of bullous pemphigoid and cicatricial pemphigoid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Wieme" 1 => "J. Lambert" 2 => "M. Moerman" 3 => "M.L. Geerts" 4 => "L. Temmerman" 5 => "J.M. Naeyaert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "18139" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "1999" "volumen" => "198" "paginaInicial" => "310" "paginaFinal" => "313" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10393462" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Black patients of African descent and HLADRB1*15:03 frequency overrepresented in epidermolysis bullosa acquisita" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Zumelzu" 1 => "C. Le Roux-Villet" 2 => "P. Loiseau" 3 => "M. Busson" 4 => "M. Heller" 5 => "F. Aucouturier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/jid.2011.231" "Revista" => array:7 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "2011" "volumen" => "131" "paginaInicial" => "2386" "paginaFinal" => "2393" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21833018" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028210022156" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalences of subacute cutaneous lupus erytematosus and epidermolysis bullosa acquisita among Korean/oriental populations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.W. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatology" "fecha" => "1998" "volumen" => "197" "paginaInicial" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9732174" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood epidermolysis bullosa acquisita: Report of three cases and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.J. Arpey" 1 => "B.E. Elewski" 2 => "D.K. Moritz" 3 => "W.R. Gammon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1991" "volumen" => "24" "paginaInicial" => "706" "paginaFinal" => "714" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1869641" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa acquisita in childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Callot-Mellot" 1 => "C. Bodemer" 2 => "F. Caux" 3 => "I. Bourgault-Villada" 4 => "S. Fraitag" 5 => "G. Goudié" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1997" "volumen" => "133" "paginaInicial" => "1122" "paginaFinal" => "1126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9301589" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital epidermolysis bullosa acquisita: Vertical transfer of maternal autoantibody from mother to infant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.L. Abrams" 1 => "A. Smidt" 2 => "L. Benjamin" 3 => "M. Chen" 4 => "D. Woodley" 5 => "A.J. Mancini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2010.317" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2011" "volumen" => "147" "paginaInicial" => "337" "paginaFinal" => "341" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21079052" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autoantibodies to type VII collagen mediate Fc gamma-dependent neutrophil activation and induce dermal-epidermal separation in cryosections of human skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Sitaru" 1 => "A. Kromminga" 2 => "T. Hashimoto" 3 => "E.B. Bröcker" 4 => "D. Zillikens" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Pathol" "fecha" => "2002" "volumen" => "161" "paginaInicial" => "301" "paginaFinal" => "311" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12107115" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Induction of dermal-epidermal separation in mice by passive transfer of antibodies specific to type VII collagen" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Sitaru" 1 => "S. Mihai" 2 => "C. Otto" 3 => "M.T. Chiriac" 4 => "I. Hausser" 5 => "B. Dotterweich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1172/JCI21386" "Revista" => array:7 [ "tituloSerie" => "J Clin Invest" "fecha" => "2005" "volumen" => "115" "paginaInicial" => "870" "paginaFinal" => "878" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15841176" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028208009564" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Induction of complement-fixing autoantibodies against type VII collagen results in subepidermal blistering in mice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Sitaru" 1 => "M.T. Chiriac" 2 => "S. Mihai" 3 => "J. Büning" 4 => "A. Gebert" 5 => "A. Ishiko" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Immunol" "fecha" => "2006" "volumen" => "177" "paginaInicial" => "3461" "paginaFinal" => "3468" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16920988" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa acquisita: Immunofluorescence, electron microscopic and immunoelectron microscopic studies in four patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Nieboer" 1 => "D.M. Boorsma" 2 => "M.J. Woerdeman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1980" "volumen" => "102" "paginaInicial" => "383" "paginaFinal" => "392" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6992836" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differentiating anti lamina lucida and anti sublamina densa anti BMZ antibodies by indirect immunofluorescence on 1.0<span class="elsevierStyleHsp" style=""></span>M sodium chloride separated skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.R. Gammon" 1 => "R.A. Briggaman" 2 => "A.O. Inman" 3 => "L.L. Queen" 4 => "C.E. Wheeler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "1984" "volumen" => "82" "paginaInicial" => "139" "paginaFinal" => "144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6363567" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct immunofluorescence studies of sodium chloride separated skin in the differential diagnosis of bullous pemphigoid and epidermolysis bullosa acquisita" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W.R. Gammon" 1 => "C. Kowalewski" 2 => "T.P. Chorzelski" 3 => "V. Kumar" 4 => "R.A. Briggaman" 5 => "E.H. Beutner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1990" "volumen" => "22" "paginaInicial" => "1990" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "U-serrated immunodeposition pattern differentiates type VII collagen targeting bullous diseases from other subepidermal bullous autoimmune diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.M. Vodegel" 1 => "M.F. Jonkman" 2 => "H.H. Pas" 3 => "M.C.J.M. de Jong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2004.06006.x" "Revista" => array:7 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2004" "volumen" => "151" "paginaInicial" => "112" "paginaFinal" => "118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15270879" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028209001113" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of ELISA for rapid detection of type VII collagen autoantibodies in epidermolysis bullosa acquisita" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Chen" 1 => "L.S. Chan" 2 => "X. Cai" 3 => "E.A. O’Toole" 4 => "J.C. Sample" 5 => "D.T. Woodley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "1997" "volumen" => "108" "paginaInicial" => "68" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8980290" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of collagen VII specific autoantibodies in patients with autoimmune and inflammatory diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Licarete" 1 => "S. Ganz" 2 => "M.J. Recknagel" 3 => "G. di Zenzo" 4 => "T. Hashimoto" 5 => "M. Hertl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2172-13-16" "Revista" => array:5 [ "tituloSerie" => "BMC Immunol" "fecha" => "2012" "volumen" => "13" "paginaInicial" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22471736" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autoantibodies from patients with BSLE inducing recruitment of leukocytes to the dermoepidermal junction and subepidermal splits in cryosections of human skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.E. Herrero-González" 1 => "J.M. Mascaró Jr." 2 => "C. Herrero" 3 => "A. Dilling" 4 => "D. Zillikens" 5 => "C. Sitaru" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.142.11.1513" "Revista" => array:7 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2006" "volumen" => "142" "paginaInicial" => "1513" "paginaFinal" => "1516" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17116854" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028208007930" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vesiculobullous systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Camisa" 1 => "H.M. Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1983" "volumen" => "9" "paginaInicial" => "924" "paginaFinal" => "933" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6358284" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028210010174" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa acquisita: What's new?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Ishii" 1 => "T. Hamada" 2 => "T. Dainichi" 3 => "T. Karashima" 4 => "T. Nakama" 5 => "S. Yasumoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1346-8138.2009.00799.x" "Revista" => array:6 [ "tituloSerie" => "J Dermatol" "fecha" => "2010" "volumen" => "37" "paginaInicial" => "220" "paginaFinal" => "230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20507385" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The many faces of epidermolysis bullosa acquisita after serration pattern analysis by direct immunofluorescence microscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.J. Buijsrogge" 1 => "G.F. Diercks" 2 => "H.H. Pas" 3 => "M.F. Jonkman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2011.10346.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2011" "volumen" => "165" "paginaInicial" => "92" "paginaFinal" => "98" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21457208" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa adcquisita retrospective clinical analysis of 30 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.H. Kim" 1 => "Y.H. Kim" 2 => "S.C. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Dermatol Venereol" "fecha" => "2011" "volumen" => "91" "paginaInicial" => "307" "paginaFinal" => "312" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and disease severity assessment of epidermolysis bullosa acquisita by ELISA for anti-type VII collagen autoantibodies: An Italian multicentre study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.V. Marzano" 1 => "E. Cozzani" 2 => "D. Fanoni" 3 => "O. de Pità" 4 => "C. Vassallo" 5 => "E. Berti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.12011" "Revista" => array:7 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2013" "volumen" => "168" "paginaInicial" => "80" "paginaFinal" => "84" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22913489" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028211028263" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and immunopathological evaluation of epidermolysis bullosa acquisita" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Delgado" 1 => "V. Aoki" 2 => "C. Santi" 3 => "T. Gabbi" 4 => "M. Sotto" 5 => "C. Maruta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2230.2011.04032.x" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2011" "volumen" => "36" "paginaInicial" => "12" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21443599" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type VII collagen exists in human intestine and serves as an antigenic target in patients with inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Chen" 1 => "E.A. O’Toole" 2 => "J. Sanghavi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "1997" "volumen" => "108" "paginaInicial" => "542" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autoimmunity against type VII collagen in inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Hundorfean" 1 => "M.F. Neurath" 2 => "C. Sitaru" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Cell Mol Med" "fecha" => "2010" "volumen" => "10" "paginaInicial" => "2393" "paginaFinal" => "2403" ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differences in direct immunofluorescence staining patterns in epidermolysis bullosa acquisita and bullous pemphigoid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.R. Smoller" 1 => "D.T. Woodley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1992" "volumen" => "27" "paginaInicial" => "674" "paginaFinal" => "678" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1430385" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermolysis bullosa acquisita: Concise review and practical considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Lehman" 1 => "M. Camilleri" 2 => "L. Gibson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2009.03886.x" "Revista" => array:7 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2009" "volumen" => "48" "paginaInicial" => "227" "paginaFinal" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19261008" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028210004656" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack69005" "titulo" => "Acknowledgments" "texto" => "<p id="par0140" class="elsevierStylePara elsevierViewall">We thank Dr C. Sitaru, who performed the type VII collagen ELISA assays, and Drs J. Herrero and A. Guilabert, who performed the immunoblotting analyses.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000010/v1_201311281142/S1578219013002412/v1_201311281142/en/main.assets" "Apartado" => array:4 [ "identificador" => "6155" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000010/v1_201311281142/S1578219013002412/v1_201311281142/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013002412?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 6 | 21 |
| 2024 October | 91 | 50 | 141 |
| 2024 September | 87 | 35 | 122 |
| 2024 August | 120 | 59 | 179 |
| 2024 July | 88 | 38 | 126 |
| 2024 June | 87 | 60 | 147 |
| 2024 May | 86 | 53 | 139 |
| 2024 April | 94 | 24 | 118 |
| 2024 March | 86 | 22 | 108 |
| 2024 February | 91 | 36 | 127 |
| 2024 January | 78 | 37 | 115 |
| 2023 December | 78 | 14 | 92 |
| 2023 November | 81 | 26 | 107 |
| 2023 October | 92 | 18 | 110 |
| 2023 September | 88 | 31 | 119 |
| 2023 August | 63 | 18 | 81 |
| 2023 July | 92 | 29 | 121 |
| 2023 June | 84 | 23 | 107 |
| 2023 May | 80 | 30 | 110 |
| 2023 April | 51 | 20 | 71 |
| 2023 March | 40 | 22 | 62 |
| 2023 February | 58 | 30 | 88 |
| 2023 January | 51 | 28 | 79 |
| 2022 December | 56 | 45 | 101 |
| 2022 November | 37 | 30 | 67 |
| 2022 October | 48 | 33 | 81 |
| 2022 September | 36 | 36 | 72 |
| 2022 August | 34 | 36 | 70 |
| 2022 July | 36 | 47 | 83 |
| 2022 June | 41 | 15 | 56 |
| 2022 May | 89 | 60 | 149 |
| 2022 April | 87 | 58 | 145 |
| 2022 March | 124 | 76 | 200 |
| 2022 February | 65 | 37 | 102 |
| 2022 January | 66 | 40 | 106 |
| 2021 December | 54 | 41 | 95 |
| 2021 November | 45 | 54 | 99 |
| 2021 October | 48 | 52 | 100 |
| 2021 September | 48 | 42 | 90 |
| 2021 August | 36 | 24 | 60 |
| 2021 July | 36 | 40 | 76 |
| 2021 June | 46 | 33 | 79 |
| 2021 May | 85 | 30 | 115 |
| 2021 April | 76 | 69 | 145 |
| 2021 March | 94 | 22 | 116 |
| 2021 February | 40 | 27 | 67 |
| 2021 January | 40 | 18 | 58 |
| 2020 December | 53 | 20 | 73 |
| 2020 November | 28 | 25 | 53 |
| 2020 October | 48 | 6 | 54 |
| 2020 September | 40 | 9 | 49 |
| 2020 August | 24 | 14 | 38 |
| 2020 July | 39 | 16 | 55 |
| 2020 June | 41 | 26 | 67 |
| 2020 May | 33 | 18 | 51 |
| 2020 April | 43 | 32 | 75 |
| 2020 March | 55 | 19 | 74 |
| 2020 February | 4 | 7 | 11 |
| 2020 January | 0 | 1 | 1 |
| 2019 December | 4 | 4 | 8 |
| 2019 November | 0 | 1 | 1 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 6 | 8 | 14 |
| 2019 August | 0 | 3 | 3 |
| 2019 July | 0 | 15 | 15 |
| 2019 June | 0 | 20 | 20 |
| 2019 May | 2 | 21 | 23 |
| 2019 April | 0 | 18 | 18 |
| 2019 March | 0 | 10 | 10 |
| 2019 February | 2 | 3 | 5 |
| 2019 January | 1 | 2 | 3 |
| 2018 December | 0 | 5 | 5 |
| 2018 November | 2 | 3 | 5 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 4 | 1 | 5 |
| 2018 August | 0 | 1 | 1 |
| 2018 March | 3 | 2 | 5 |
| 2018 February | 48 | 4 | 52 |
| 2018 January | 65 | 6 | 71 |
| 2017 December | 78 | 7 | 85 |
| 2017 November | 78 | 5 | 83 |
| 2017 October | 76 | 8 | 84 |
| 2017 September | 62 | 10 | 72 |
| 2017 August | 81 | 11 | 92 |
| 2017 July | 56 | 8 | 64 |
| 2017 June | 77 | 31 | 108 |
| 2017 May | 54 | 10 | 64 |
| 2017 April | 42 | 22 | 64 |
| 2017 March | 27 | 56 | 83 |
| 2017 February | 58 | 10 | 68 |
| 2017 January | 66 | 13 | 79 |
| 2016 December | 85 | 6 | 91 |
| 2016 November | 111 | 22 | 133 |
| 2016 October | 132 | 32 | 164 |
| 2016 September | 215 | 11 | 226 |
| 2016 August | 157 | 9 | 166 |
| 2016 July | 56 | 3 | 59 |
| 2016 June | 7 | 11 | 18 |
| 2016 May | 6 | 7 | 13 |
| 2016 April | 5 | 2 | 7 |
| 2016 March | 11 | 9 | 20 |
| 2016 February | 12 | 1 | 13 |
| 2016 January | 6 | 2 | 8 |
| 2015 December | 5 | 3 | 8 |
| 2015 November | 10 | 1 | 11 |
| 2015 October | 4 | 4 | 8 |
| 2015 September | 3 | 3 | 6 |
| 2015 August | 9 | 1 | 10 |
| 2015 July | 94 | 10 | 104 |
| 2015 June | 58 | 4 | 62 |
| 2015 May | 75 | 10 | 85 |
| 2015 April | 62 | 4 | 66 |
| 2015 March | 81 | 9 | 90 |
| 2015 February | 90 | 4 | 94 |
| 2015 January | 76 | 6 | 82 |
| 2014 December | 69 | 5 | 74 |
| 2014 November | 50 | 5 | 55 |
| 2014 October | 66 | 6 | 72 |
| 2014 September | 68 | 3 | 71 |
| 2014 August | 58 | 4 | 62 |
| 2014 July | 38 | 7 | 45 |
| 2014 June | 60 | 10 | 70 |
| 2014 May | 61 | 9 | 70 |
| 2014 April | 48 | 7 | 55 |
| 2014 March | 67 | 8 | 75 |
| 2014 February | 47 | 5 | 52 |
| 2014 January | 51 | 10 | 61 |
| 2013 December | 55 | 16 | 71 |
| 2013 November | 1 | 0 | 1 |
Show all
