Case and Research Letter
Pachydermodactyly Successfully Treated With Triamcinolone Injections
Paquidermodactilia tratada con éxito con infiltraciones de triamcinolona
A. Plana Pla
, J. Bassas Vila, M.A. Toro Montecinos, C. Ferrandiz Foraster
Corresponding author
Departamento de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
Read
11935
Timeswas read the article
2918
Total PDF
9017
Total HTML
Share statistics
array:24 [ "pii" => "S1578219014000420" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.04.024" "estado" => "S300" "fechaPublicacion" => "2014-04-01" "aid" => "856" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2012" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:319-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3565 "formatos" => array:3 [ "EPUB" => 41 "HTML" => 2666 "PDF" => 858 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731013002329" "issn" => "00017310" "doi" => "10.1016/j.ad.2013.04.010" "estado" => "S300" "fechaPublicacion" => "2014-04-01" "aid" => "856" "copyright" => "Elsevier España, S.L. y AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:319-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2993 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 2041 "PDF" => 950 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Paquidermodactilia tratada con éxito con infiltraciones de triamcinolona" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "319" "paginaFinal" => "321" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pachydermodactyly Successfully Treated With Triamcinolone Injections" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3333 "Ancho" => 1576 "Tamanyo" => 2179468 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A. Imagen histológica en la que se observa un engrosamiento de la dermis con aumento tanto de las fibras de colágeno como en menor medida de los fibroblastos (Hematoxilina-eosina, x10). B. Imagen histológica ampliada en la que se puede observar el aumento de las fibras de colágeno y de los fibroblastos (Hematoxilina-eosina, x20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Plana Pla, J. Bassas Vila, M.A. Toro Montecinos, C. Ferrandiz Foraster" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Plana Pla" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Bassas Vila" ] 2 => array:2 [ "nombre" => "M.A." "apellidos" => "Toro Montecinos" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Ferrandiz Foraster" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219014000420" "doi" => "10.1016/j.adengl.2013.04.024" "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/S1578219014000420?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013002329?idApp=UINPBA000044" "url" => "/00017310/0000010500000003/v1_201404040105/S0001731013002329/v1_201404040105/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219014000456" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.05.007" "estado" => "S300" "fechaPublicacion" => "2014-04-01" "aid" => "865" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:322-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2699 "formatos" => array:3 [ "EPUB" => 37 "HTML" => 2042 "PDF" => 620 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case And Research Letter</span>" "titulo" => "Acral Erosions and Ulcers: An Early Sign of Severe Acute Methotrexate Toxicity" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "322" "paginaFinal" => "323" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Erosiones y úlceras acrales: manifestación precoz de toxicidad aguda grave por metrotexato" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 662 "Ancho" => 1002 "Tamanyo" => 134953 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B, Bilateral, symmetrical, crusted erosive lesions with a retiform distribution on the dorsum of the feet and hands.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Maroñas-Jiménez, M. Castellanos-González, J. Sanz Bueno, F. Vanaclocha Sebastián" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Maroñas-Jiménez" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Castellanos-González" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Sanz Bueno" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Vanaclocha Sebastián" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013002536" "doi" => "10.1016/j.ad.2013.05.006" "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/S0001731013002536?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000456?idApp=UINPBA000044" "url" => "/15782190/0000010500000003/v1_201404030048/S1578219014000456/v1_201404030048/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219014000419" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.04.023" "estado" => "S300" "fechaPublicacion" => "2014-04-01" "aid" => "855" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:317-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1728 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 1240 "PDF" => 436 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CASE AND RESEARCH LETTER</span>" "titulo" => "Skin Toxicity Due to Telaprevir: A New Drug We Should Be Familiar With" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "317" "paginaFinal" => "319" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Toxicidad cutánea por telaprevir: un nuevo fármaco que es necesario conocer" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1353 "Ancho" => 901 "Tamanyo" => 158178 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Urticarial rash with an annular morphology that affected around 30% of the body surface area and was most prominent on the proximal third of the lower limbs.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.T. López-Villaescusa, L.J. Pérez-García, M. Rodríguez-Vázquez, M.L. Martínez-Martínez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.T." "apellidos" => "López-Villaescusa" ] 1 => array:2 [ "nombre" => "L.J." "apellidos" => "Pérez-García" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Rodríguez-Vázquez" ] 3 => array:2 [ "nombre" => "M.L." "apellidos" => "Martínez-Martínez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013002317" "doi" => "10.1016/j.ad.2013.04.009" "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/S0001731013002317?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000419?idApp=UINPBA000044" "url" => "/15782190/0000010500000003/v1_201404030048/S1578219014000419/v1_201404030048/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Pachydermodactyly Successfully Treated With Triamcinolone Injections" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "319" "paginaFinal" => "321" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Plana Pla, J. Bassas Vila, M.A. Toro Montecinos, C. Ferrandiz Foraster" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Plana Pla" "email" => array:1 [ 0 => "adriplanapla@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Bassas Vila" ] 2 => array:2 [ "nombre" => "M.A." "apellidos" => "Toro Montecinos" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Ferrandiz Foraster" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paquidermodactilia tratada con éxito con infiltraciones de triamcinolona" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1375 "Ancho" => 901 "Tamanyo" => 176488 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pretreatment photograph showing the conspicuous, diffuse thickening around the proximal interphalangeal joints of all the fingers with the exception of the thumb and fifth finger.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pachydermodactyly, from the Greek pachy (thick), dermos (skin), and dactylos (digits), is a very rare form of acquired benign digital fibromatosis. It is characterized clinically swelling of the medial and lateral aspects of the proximal interphalangeal joints of practically all the fingers of the hands (with the exception of the thumb). We describe a clinically striking new case that responded satisfactorily to corticosteroid infiltration and we discuss the different therapeutic options available.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 15-year-old patient with no past medical history of interest was referred to dermatology outpatients for evaluation of thickening of the second, third, and fourth fingers of both hands that had started to develop 2 years earlier. An additional finding was that the patient attended a gymnasium 4 days a week to perform weight training.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed very marked, diffuse thickening at the level of the proximal interphalangeal joints of all the fingers of the hands, except the thumbs and fifth fingers. Movement was not limited (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and there were no others skin changes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histology of a skin biopsy taken from the lateral aspect of the second finger of the right hand showed thickening of the dermis with an increase both in collagen fibers and, to a lesser extent, in fibroblasts (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>, A and B). Few changes were detected in the epidermis, though minimal hyperkeratosis with compact orthokeratosis was observed.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A full laboratory work-up, including renal and liver function and markers of autoimmunity, was completely normal. X-rays of the hands showed no bone or joint abnormalities, and magnetic resonance revealed thickening of the dermis that extended down to the subcutaneous cellular tissue.</p><p id="par0030" class="elsevierStylePara elsevierViewall">It was decided to treat the patient with corticosteroid injections into the affected area. We used a solution of triamcinolone acetonide, 40 mg/mL, mixed with an equal volume of 2% mepivacaine solution, and performed injections (2-3<span class="elsevierStyleHsp" style=""></span>mL of the solution into each thickened area) in 2 sessions, 2 months apart. This achieved a marked decrease in the size and firmness of the lesions after the 2 sessions (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Pachydermodactyly is a rare condition, with only 80 published cases to date.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is included in the group of the fibromatoses and since it was first described by Bazex et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in 1973 it has been referred to by various names, including knuckle pads, pseudo-knuckle pads, heloderma, and subcutaneous fibroma.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Our patient presented a model case with regard to age and sex, as pachydermodactyly is usually seen in young patients (mean age at presentation, 21.2 years), although the age range of published cases is from 5 to 69 years, and the condition is more common in men, with a male to female ratio of 3 to 2.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This predominance in men has been related to the possible etiology and pathogenesis of the disorder as, although this is not yet fully understood, it has been suggested that pachydermodactyly may be a reactive disorder secondary to repeated minor exogenous trauma.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This proposal is based on the finding that pachydermodactyly shows a relationship with numerous occupations and activities such as martial arts and climbing,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> work in food-processing factories,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> patients with obsessive compulsive disorders associated with tics affecting the hands,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> or weight lifting, as in the case we present.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Our case is also highly illustrative of the clinical manifestations, as the typical findings are asymptomatic and symmetrical swelling of the sides of the fingers. The second, third, and fourth fingers are most commonly affected, but the fifth finger and even the dorsum of the hand can occasionally be affected.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> There are usually no epidermal changes, though mild erythema, fine desquamation, or lichenification may sometimes be observed.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,7</span></a> Hand movements are not affected.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The diagnosis is clinical. The most typical findings on histology are a thickening of the dermis, which may be accompanied by a benign proliferation of fibroblasts, and an increase in collagen fibers that extends down to the subcutaneous cellular tissue. Hyperkeratosis (ortokeratosis or parakeratosis) may also be observed, as well as a decrease in the elastic fibers and mucin.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Plain x-rays are normal and magnetic resonance shows an increase in soft tissue volume around the joints.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The main differential diagnosis is with knuckle pads. These nodules, which can be idiopathic (true) or due to recurrent trauma (pseudo-knuckle pads), are differentiated from pachydermodactyly by the site of the lesions; in pachydermodactyly the lesions typically affect the sides of the fingers whereas knuckle pads are found on the dorsal surface. In addition, they are usually more circumscribed lesions.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Another disease that we must consider is juvenile hyaline fibromatosis. This disease, due to a genetic abnormality that alters the regulation of collagen synthesis, leads to the appearance of multiple subcutaneous nodules on the fingers. However, it also causes other changes, such as bone lesions, ulceration, gingival hypertrophy, and tumors on the scalp and nose.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Certain types of polyarthritis that affect the proximal interphalangeal joints, such as psoriatic arthritis and rheumatoid arthritis, must also be considered in the differential diagnosis. The diagnosis of these dermatoses is facilitated by the clear presence of inflammatory signs.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Published reports on pachydermodactyly focus little on its treatment. Some authors even advocate therapeutic abstention, suggesting only that patients stop performing the activities that gave rise to the exogenous trauma. This approach comes from the fact that pachydermodactyly is a benign dermatosis that interferes little with movement. However, in our opinion, the disease can have a significant impact on the quality of life of some patients, and therapy should not therefore be ignored. At the present time, the 2 treatment options considered are local corticosteroid infiltration and surgical treatment by resection of the fibrous tissue.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Descriptions on how to perform these procedures (the surgical technique or the dose and regimen of corticosteroid infiltration) are scarce.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In our patient we used a solution of triamcinolone acetonide, 40 mg/mL, mixed with an equal volume of 2% mepivacaine solution, and we performed injections in 2 sessions, 2 months apart. At each session we injected a total of 2-3<span class="elsevierStyleHsp" style=""></span>mL of the solution into each thickened area. The cosmetic result was acceptable, and there was mild periarticular hypopigmentation. Thus, with the caution that comes from a report of a single case, we propose this therapeutic regimen as one of the treatment options in similar cases.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Plana Pla A, Bassas Vila J, Toro Montecinos M, Ferrandiz Foraster C. Paquidermodactilia tratada con éxito con infiltraciones de triamcinolona. Actas Dermosifiliogr. 2014 105:319–321.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1375 "Ancho" => 901 "Tamanyo" => 176488 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pretreatment photograph showing the conspicuous, diffuse thickening around the proximal interphalangeal joints of all the fingers with the exception of the thumb and fifth finger.</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" => 2001 "Ancho" => 946 "Tamanyo" => 1008226 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Histology image in which thickening of the dermis may be observed, associated with an increase of both collagen fibers and, to a lesser extent, fibroblasts (hematoxylin-eosin, original magnification x10). B, Histology image at higher magnification showing the increase of the collagen fibers and fibroblasts (hematoxylin-eosin, original magnification x20).</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" => 856 "Ancho" => 951 "Tamanyo" => 102115 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Photograph taken 2 months after the second session of injections. There is a visible reduction in the periarticular swelling and slight hypopigmentation secondary to the treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pachydermodactyly–Just a sign of emotional distress" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Beltraminelli" 1 => "P. Itin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1684/ejd.2008.0543" "Revista" => array:7 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2009" "volumen" => "19" "paginaInicial" => "5" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19059823" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0091674912007804" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pachydermie digitale des premieres phalanges par hyperplasie conjonctive dermique et aplasie hypodermique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Bazex" 1 => "A. Dupre" 2 => "J. Teillard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Bull Soc Fr Dermatol Syphiligr" "fecha" => "1973" "volumen" => "80" "paginaInicial" => "455" "paginaFinal" => "458" "itemHostRev" => array:3 [ "pii" => "S0091674902837940" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pachydermodactyly from repetitive motion in poultry processing workers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.J. Sagransky" 1 => "R.O. Pichardo-Geisinger" 2 => "D. Muñoz-Ali" 3 => "S.R. Feldman" 4 => "D.C. Mora" 5 => "S.A. Quandt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2012.983" "Revista" => array:7 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2012" "volumen" => "148" "paginaInicial" => "925" "paginaFinal" => "928" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22911188" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0091674909010112" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pachydermodactyly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Hunt" 1 => "R. Mandal" 2 => "R. Walters" 3 => "J.V. Schaffer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Online J" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21199631" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S009167491100368X" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paquidermodactilia: una forma poco frecuente de fibromatosis digital adquirida" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.M. Morales Callaghan" 1 => "C. Horndler Argarate" 2 => "F.J. García Latasa de Araníbar" 3 => "M.L. Zubiri Ara" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2010" "volumen" => "101" "paginaInicial" => "652" "paginaFinal" => "654" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20858397" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0091674910010602" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pachydermodactyly: Reflecting obsessive-compulsive behaviour?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Lautenschlager" 1 => "P. Itin" 2 => "T. Rufli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1994" "volumen" => "130" "paginaInicial" => "387" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8129422" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pachydermodactyly or acquired digital fibromatosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Meunier" 1 => "C. Pailler" 2 => "G. Barneon" 3 => "J. Meynadier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1994" "volumen" => "131" "paginaInicial" => "744" "paginaFinal" => "746" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7999628" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pachydermodactyly: Four additional cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Sandobal" 1 => "A. Kuznietz" 2 => "A. Varizat" 3 => "S. Roverano" 4 => "S. Paira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-006-0210-9" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "962" "paginaFinal" => "964" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16552467" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000003/v1_201404030048/S1578219014000420/v1_201404030048/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000003/v1_201404030048/S1578219014000420/v1_201404030048/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000420?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 29 | 6 | 35 |
| 2024 October | 234 | 47 | 281 |
| 2024 September | 174 | 29 | 203 |
| 2024 August | 256 | 58 | 314 |
| 2024 July | 208 | 33 | 241 |
| 2024 June | 208 | 37 | 245 |
| 2024 May | 187 | 64 | 251 |
| 2024 April | 163 | 27 | 190 |
| 2024 March | 166 | 37 | 203 |
| 2024 February | 196 | 40 | 236 |
| 2024 January | 145 | 41 | 186 |
| 2023 December | 186 | 16 | 202 |
| 2023 November | 129 | 30 | 159 |
| 2023 October | 141 | 30 | 171 |
| 2023 September | 115 | 37 | 152 |
| 2023 August | 104 | 30 | 134 |
| 2023 July | 107 | 39 | 146 |
| 2023 June | 112 | 23 | 135 |
| 2023 May | 149 | 35 | 184 |
| 2023 April | 96 | 31 | 127 |
| 2023 March | 105 | 21 | 126 |
| 2023 February | 118 | 32 | 150 |
| 2023 January | 108 | 34 | 142 |
| 2022 December | 87 | 51 | 138 |
| 2022 November | 59 | 39 | 98 |
| 2022 October | 40 | 29 | 69 |
| 2022 September | 52 | 45 | 97 |
| 2022 August | 55 | 36 | 91 |
| 2022 July | 28 | 38 | 66 |
| 2022 June | 34 | 29 | 63 |
| 2022 May | 105 | 47 | 152 |
| 2022 April | 123 | 26 | 149 |
| 2022 March | 90 | 52 | 142 |
| 2022 February | 120 | 48 | 168 |
| 2022 January | 139 | 72 | 211 |
| 2021 December | 124 | 60 | 184 |
| 2021 November | 115 | 59 | 174 |
| 2021 October | 111 | 62 | 173 |
| 2021 September | 119 | 40 | 159 |
| 2021 August | 113 | 36 | 149 |
| 2021 July | 142 | 40 | 182 |
| 2021 June | 162 | 35 | 197 |
| 2021 May | 150 | 31 | 181 |
| 2021 April | 274 | 115 | 389 |
| 2021 March | 145 | 42 | 187 |
| 2021 February | 92 | 33 | 125 |
| 2021 January | 64 | 18 | 82 |
| 2020 December | 52 | 20 | 72 |
| 2020 November | 49 | 18 | 67 |
| 2020 October | 56 | 19 | 75 |
| 2020 September | 41 | 21 | 62 |
| 2020 August | 26 | 25 | 51 |
| 2020 July | 25 | 12 | 37 |
| 2020 June | 30 | 36 | 66 |
| 2020 May | 22 | 16 | 38 |
| 2020 April | 42 | 20 | 62 |
| 2020 March | 25 | 9 | 34 |
| 2020 February | 5 | 4 | 9 |
| 2020 January | 0 | 2 | 2 |
| 2019 December | 4 | 23 | 27 |
| 2019 November | 0 | 7 | 7 |
| 2019 October | 0 | 4 | 4 |
| 2019 September | 4 | 13 | 17 |
| 2019 August | 0 | 4 | 4 |
| 2019 July | 0 | 16 | 16 |
| 2019 June | 2 | 20 | 22 |
| 2019 May | 1 | 80 | 81 |
| 2019 April | 0 | 59 | 59 |
| 2019 March | 2 | 7 | 9 |
| 2019 February | 4 | 9 | 13 |
| 2019 January | 1 | 11 | 12 |
| 2018 December | 0 | 1 | 1 |
| 2018 November | 1 | 1 | 2 |
| 2018 October | 5 | 0 | 5 |
| 2018 September | 4 | 2 | 6 |
| 2018 August | 0 | 6 | 6 |
| 2018 July | 0 | 18 | 18 |
| 2018 June | 0 | 6 | 6 |
| 2018 April | 0 | 7 | 7 |
| 2018 March | 11 | 6 | 17 |
| 2018 February | 70 | 12 | 82 |
| 2018 January | 62 | 9 | 71 |
| 2017 December | 67 | 11 | 78 |
| 2017 November | 64 | 14 | 78 |
| 2017 October | 64 | 11 | 75 |
| 2017 September | 63 | 25 | 88 |
| 2017 August | 71 | 19 | 90 |
| 2017 July | 75 | 20 | 95 |
| 2017 June | 78 | 16 | 94 |
| 2017 May | 92 | 21 | 113 |
| 2017 April | 70 | 14 | 84 |
| 2017 March | 75 | 16 | 91 |
| 2017 February | 81 | 22 | 103 |
| 2017 January | 77 | 14 | 91 |
| 2016 December | 70 | 16 | 86 |
| 2016 November | 120 | 17 | 137 |
| 2016 October | 112 | 34 | 146 |
| 2016 September | 147 | 18 | 165 |
| 2016 August | 90 | 18 | 108 |
| 2016 July | 56 | 13 | 69 |
| 2016 June | 7 | 8 | 15 |
| 2016 May | 7 | 15 | 22 |
| 2016 April | 3 | 18 | 21 |
| 2016 March | 3 | 2 | 5 |
| 2016 February | 2 | 12 | 14 |
| 2016 January | 10 | 2 | 12 |
| 2015 December | 9 | 9 | 18 |
| 2015 November | 8 | 2 | 10 |
| 2015 October | 9 | 8 | 17 |
| 2015 September | 9 | 10 | 19 |
| 2015 August | 6 | 3 | 9 |
| 2015 July | 128 | 22 | 150 |
| 2015 June | 97 | 5 | 102 |
| 2015 May | 94 | 11 | 105 |
| 2015 April | 65 | 5 | 70 |
| 2015 March | 74 | 9 | 83 |
| 2015 February | 60 | 6 | 66 |
| 2015 January | 74 | 6 | 80 |
| 2014 December | 84 | 8 | 92 |
| 2014 November | 51 | 5 | 56 |
| 2014 October | 35 | 2 | 37 |
| 2014 September | 31 | 3 | 34 |
| 2014 August | 29 | 6 | 35 |
| 2014 July | 28 | 8 | 36 |
| 2014 June | 35 | 5 | 40 |
| 2014 May | 42 | 13 | 55 |
| 2014 April | 22 | 13 | 35 |
Show all
