Case and Research Letter
Ultrasound Monitoring of Childhood Linear Morphea
Monitorización ecográfica de la morfea lineal de la infancia
I. Pérez-López
, C. Garrido-Colmenero, R. Ruiz-Villaverde, J. Tercedor-Sánchez
Corresponding author
Unidad de Gestión Clínica de Dermatología Médico Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, Spain
Read
7108
Timeswas read the article
2028
Total PDF
5080
Total HTML
Share statistics
array:23 [ "pii" => "S1578219015000670" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.03.017" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "1087" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2014" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:340-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1317 "formatos" => array:3 [ "EPUB" => 50 "HTML" => 874 "PDF" => 393 ] ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S0001731014004797" "issn" => "00017310" "doi" => "10.1016/j.ad.2014.09.012" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "1087" "copyright" => "Elsevier España, S.L.U. y AEDV" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:340-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1268 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 621 "PDF" => 645 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Monitorización ecográfica de la morfea lineal de la infancia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "340" "paginaFinal" => "342" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Ultrasound Monitoring of Childhood Linear Morphea" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 746 "Ancho" => 995 "Tamanyo" => 101229 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Área deprimida lineal en el hemilabio superior de nuestro paciente.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Pérez-López, C. Garrido-Colmenero, R. Ruiz-Villaverde, J. Tercedor-Sánchez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Pérez-López" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Garrido-Colmenero" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Tercedor-Sánchez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219015000670" "doi" => "10.1016/j.adengl.2015.03.017" "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/S1578219015000670?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014004797?idApp=UINPBA000044" "url" => "/00017310/0000010600000004/v2_201505051016/S0001731014004797/v2_201505051016/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1578219015000888" "issn" => "15782190" "doi" => "10.1016/j.adengl.2014.09.020" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "1063" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:343" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 594 "formatos" => array:3 [ "EPUB" => 51 "HTML" => 382 "PDF" => 161 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Acute Parvovirus B19 Infection in Adults" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "343" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Parpovirus B19 infección en adultos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Sai Tin, V. Wiwanitkit" "autores" => array:2 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Sai Tin" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Wiwanitkit" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0001731014004475" "doi" => "10.1016/j.ad.2014.09.005" "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/S0001731014004475?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000888?idApp=UINPBA000044" "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000888/v2_201505051007/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1578219015000669" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.03.016" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "1075" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:339-40" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1148 "formatos" => array:3 [ "EPUB" => 32 "HTML" => 647 "PDF" => 469 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Value of Dermoscopy in the Diagnosis and Prognostic Evaluation of Linear Pigmented Lichen Planus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "339" "paginaFinal" => "340" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aportación de la dermatoscopia en el diagnóstico y pronóstico del liquen plano pigmentado lineal" ] ] "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" => 746 "Ancho" => 995 "Tamanyo" => 300898 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A dense band-like inflammatory infiltrate can be seen at the interface, with vacuolar degeneration of the basal layer and scattered apoptotic keratinocytes (hematoxylin and eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>10).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Baquero Sánchez, A.I. Lorente-Lavirgen, J. Domínguez Cruz, J. Conejo-Mir" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Baquero Sánchez" ] 1 => array:2 [ "nombre" => "A.I." "apellidos" => "Lorente-Lavirgen" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Domínguez Cruz" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Conejo-Mir" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731014004591" "doi" => "10.1016/j.ad.2014.09.011" "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/S0001731014004591?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000669?idApp=UINPBA000044" "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000669/v2_201505051007/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Ultrasound Monitoring of Childhood Linear Morphea" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "340" "paginaFinal" => "342" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Pérez-López, C. Garrido-Colmenero, R. Ruiz-Villaverde, J. Tercedor-Sánchez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Pérez-López" "email" => array:1 [ 0 => "ipl_elmadrono@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Garrido-Colmenero" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Tercedor-Sánchez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Monitorización ecográfica de la morfea lineal de la infancia" ] ] "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" => 1244 "Ancho" => 1659 "Tamanyo" => 207397 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Depressed linear lesion on the left upper lip in our patient.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Morphea is a form of localized scleroderma that differs from systemic forms of the disease by the presence of well-characterized morphological variants and the absence of any clinically detectable extracutaneous involvement. Many clinical classifications are employed, but there are few management guidelines for use in daily clinical practice.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The most recently published guideline includes the following clinical variants: circumscribed morphea, generalized morphea, and the linear variant, which is more typical in childhood.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The linear variant is subdivided into 3 subtypes: the purely linear form, coup de sabre morphea, and progressive facial hemiatrophy (or Parry-Romberg syndrome).</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 7-year-old boy with no past medical or family history of interest. He was seen for a 7-mm long, depressed, hypopigmented, slightly indurated band located on the left upper lip (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesion had appeared more than 18 months earlier and had not previously been treated.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The possibility of performing a diagnostic biopsy was discussed with the family, but, given the cosmetic repercussion, it was decided to use skin ultrasound to confirm the clinical diagnostic suspicion. The ultrasound device employed was the Mylab™25 (Esaote) with a compact linear 18<span class="elsevierStyleHsp" style=""></span>MHz probe. The study was used to support the clinical diagnosis and in particular to ensure correct monitoring of the disease. To perform an accurate study of dermal and epidermal thickness requires a thick layer of gel to obtain a high-quality image; pressure must not be applied to the skin, as this could distort the image. The ultrasound image revealed thinning of the epidermal layer and of the dermosubdermal space, with increased echogenicity of the dermis compared with the adjacent skin (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Doppler mode did not reveal increased vascularization in the area of the lesion. The neurological examination was rigorously normal, and additional laboratory tests were not requested. A diagnosis of inactive linear morphea was made on the basis of the clinical appearance and a compatible ultrasound image, and it was decided to take a wait-and-see approach.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Localized linear scleroderma is characterized by the presence of sclerotic bands with a linear distribution and hypo- or hyperpigmentation; the bands usually arise on the upper or lower limbs. These linear lesions may follow the Blaschko lines, signifying that genetic mosaicism may contribute to the pathophysiology of the disease.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Large, deep lesions may be associated with muscle and bone atrophy and functional limitation due to joint involvement.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Ultrasound is a useful method for the diagnosis and, in particular, for the follow-up of diseases that affect the dermis and subcutaneous cellular tissue.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> Although the ultrasound findings are sometimes nonspecific, as occurred in our case, they can be very useful when combined with the patient's clinical manifestations to clarify the differential diagnosis. Most research into linear scleroderma reported in the literature describes the use of 20<span class="elsevierStyleHsp" style=""></span>MHz probes, as they reach a maximum depth of 10<span class="elsevierStyleHsp" style=""></span>mm, which should be sufficient to determine the thickness and echogenicity of the lesion.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Evaluation of the clinical activity of localized scleroderma can be complicated, as it is based on observation of the clinical manifestations: presence or absence of erythema, lesion spread, or appearance of new lesions.</p><p id="par0035" class="elsevierStylePara elsevierViewall">However, the progression of morphea can initially affect deeper layers and be clinically undetectable. This can delay the early initiation of treatment.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The difference in thickness between affected skin and normal skin does not correlate with disease activity. The different characteristics that should be taken into consideration are overall echogenicity of the lesion, hypoechogenicity of the hypodermis, and increased vascularization of the deep dermis. These parameters, which do appear to correlate with increased clinical activity,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> were evaluated in our patient and enabled us to take a wait-and-see approach. When morphea is in a clinically stable phase, skin ultrasound reveals only a minimal difference in overall echogenicity between affected skin and normal skin, as was found in our patient.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, skin ultrasound is a non-invasive technique that can reduce the need for skin biopsy, particularly when the clinical findings are highly suggestive, as in our patient, or when histology has already been performed, avoiding cosmetic repercussions in visible areas. The dermatologist must learn to perform ultrasound studies, as they enable plaques of morphea to be monitored and contribute not only to the ability to take a wait-and-see approach but also to monitoring the efficacy of treatments.</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: Pérez-López I, Garrido-Colmenero C, Ruiz-Villaverde R, Tercedor-Sánchez J. Monitorización ecográfica de la morfea lineal de la infancia. Actas Dermosifiliogr. 2015;106:340–342.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1244 "Ancho" => 1659 "Tamanyo" => 207397 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Depressed linear lesion on the left upper lip in our patient.</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" => 1148 "Ancho" => 1661 "Tamanyo" => 142677 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Reduced thickness of the epidermal layer and of the dermosubdermal space with increased echogenicity of the dermis compared with the adjacent skin of normal appearance. The arrow indicates the layer of gel.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Kreuter A, Krieg T, Worm M, Wenzel J, Gambichler T, Kuhn A, et al.; Deutsche Dermatologische Gesellschaft. AWMF Guideline n.<span class="elsevierStyleSup">o</span> 013/066. Diagnosis and therapy of circumscribed scleroderma. J Dtsch Dermatol Ges. 2009;7<span class="elsevierStyleHsp" style=""></span>Suppl 6:S1-14." ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actualización en la clasificación y el tratamiento de la esclerodermia localizada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I. Bielsa-Marsol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.adengl.2012.10.012" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2013" "volumen" => "104" "paginaInicial" => "654" "paginaFinal" => "666" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23948159" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morfea siguiendo las líneas de Blaschko estrechas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.M. Coronel" 1 => "A. Hernandez" 2 => "I. Colmenero" 3 => "A. Torrelo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2009" "volumen" => "100" "paginaInicial" => "341" "paginaFinal" => "342" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19463245" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Common applications of dermatologic sonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "X. Wortsman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "97" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22215775" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0213005X13003868" "estado" => "S300" "issn" => "0213005X" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High frequency ultrasound can detect improvement of lesions in juvenile localized scleroderma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Porta" 1 => "O. Kaloudi" 2 => "A. Garzitto" 3 => "F. Prignano" 4 => "F. Nacci" 5 => "F. Falcini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/14397595.2013.844301" "Revista" => array:6 [ "tituloSerie" => "Mod Rheumatol." "fecha" => "2014" "volumen" => "24" "paginaInicial" => "869" "paginaFinal" => "873" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24251994" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound as an outcome measure to assess disease activity in disorders of skin thickening: An example of the use of radiologic techniques to assess skin disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.E. Bendeck" 1 => "H.T. Jacobe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1529-8019.2007.00116.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Ther" "fecha" => "2007" "volumen" => "20" "paginaInicial" => "86" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17537136" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulsed high-dose corticosteroids combined with low-dose methotrexate in severe localized scleroderma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Kreuter" 1 => "T. Gambichler" 2 => "F. Breuckmann" 3 => "S. Rotterdam" 4 => "M. Freitag" 5 => "M. Stuecker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.141.7.847" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2005" "volumen" => "141" "paginaInicial" => "847" "paginaFinal" => "852" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16027298" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of doppler ultrasound to evaluate lesions of localized scleroderma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.C. Li" 1 => "M.S. Liebling" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Rheumatol Rep" "fecha" => "2009" "volumen" => "11" "paginaInicial" => "205" "paginaFinal" => "211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19604465" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Initial evaluation of an ultrasound measure for assessing the activity of skin lesions in juvenile localized scleroderma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.C. Li" 1 => "M.S. Liebling" 2 => "K.A. Haines" 3 => "J.E. Weiss" 4 => "A. Prann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arthritis Care Res (Hoboken)" "fecha" => "2011" "volumen" => "63" "paginaInicial" => "735" "paginaFinal" => "742" "itemHostRev" => array:3 [ "pii" => "S0140673614606863" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sonographic evaluation of pediatric localized scleroderma: Preliminary disease assessment measures" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.C. Li" 1 => "M.S. Liebling" 2 => "F.G. Ramji" 3 => "S. Opitz" 4 => "A. Mohanta" 5 => "T. Kornyat" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Pediatr Rheumatol Online J." "fecha" => "2010" "volumen" => "27" "paginaInicial" => "14" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000670/v2_201505051007/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/15782190/0000010600000004/v2_201505051007/S1578219015000670/v2_201505051007/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000670?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 8 | 16 |
| 2024 October | 82 | 42 | 124 |
| 2024 September | 91 | 23 | 114 |
| 2024 August | 120 | 59 | 179 |
| 2024 July | 123 | 48 | 171 |
| 2024 June | 101 | 44 | 145 |
| 2024 May | 103 | 35 | 138 |
| 2024 April | 113 | 27 | 140 |
| 2024 March | 78 | 50 | 128 |
| 2024 February | 77 | 30 | 107 |
| 2024 January | 68 | 34 | 102 |
| 2023 December | 68 | 11 | 79 |
| 2023 November | 79 | 35 | 114 |
| 2023 October | 83 | 31 | 114 |
| 2023 September | 63 | 25 | 88 |
| 2023 August | 54 | 20 | 74 |
| 2023 July | 117 | 48 | 165 |
| 2023 June | 67 | 24 | 91 |
| 2023 May | 88 | 23 | 111 |
| 2023 April | 120 | 24 | 144 |
| 2023 March | 107 | 28 | 135 |
| 2023 February | 99 | 31 | 130 |
| 2023 January | 86 | 30 | 116 |
| 2022 December | 79 | 38 | 117 |
| 2022 November | 70 | 26 | 96 |
| 2022 October | 60 | 29 | 89 |
| 2022 September | 48 | 37 | 85 |
| 2022 August | 36 | 25 | 61 |
| 2022 July | 32 | 28 | 60 |
| 2022 June | 40 | 19 | 59 |
| 2022 May | 106 | 34 | 140 |
| 2022 April | 104 | 31 | 135 |
| 2022 March | 83 | 40 | 123 |
| 2022 February | 74 | 24 | 98 |
| 2022 January | 120 | 30 | 150 |
| 2021 December | 84 | 41 | 125 |
| 2021 November | 78 | 40 | 118 |
| 2021 October | 75 | 50 | 125 |
| 2021 September | 64 | 30 | 94 |
| 2021 August | 127 | 27 | 154 |
| 2021 July | 80 | 29 | 109 |
| 2021 June | 62 | 22 | 84 |
| 2021 May | 74 | 19 | 93 |
| 2021 April | 100 | 36 | 136 |
| 2021 March | 110 | 15 | 125 |
| 2021 February | 76 | 31 | 107 |
| 2021 January | 38 | 26 | 64 |
| 2020 December | 55 | 15 | 70 |
| 2020 November | 30 | 16 | 46 |
| 2020 October | 36 | 11 | 47 |
| 2020 September | 40 | 19 | 59 |
| 2020 August | 39 | 17 | 56 |
| 2020 July | 31 | 14 | 45 |
| 2020 June | 55 | 26 | 81 |
| 2020 May | 25 | 23 | 48 |
| 2020 April | 43 | 23 | 66 |
| 2020 March | 30 | 14 | 44 |
| 2020 February | 9 | 1 | 10 |
| 2020 January | 4 | 2 | 6 |
| 2019 December | 8 | 2 | 10 |
| 2019 November | 4 | 2 | 6 |
| 2019 October | 0 | 3 | 3 |
| 2019 September | 10 | 3 | 13 |
| 2019 August | 4 | 3 | 7 |
| 2019 July | 2 | 4 | 6 |
| 2019 June | 4 | 6 | 10 |
| 2019 May | 4 | 32 | 36 |
| 2019 April | 0 | 11 | 11 |
| 2019 March | 0 | 5 | 5 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 1 | 1 | 2 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 5 | 1 | 6 |
| 2018 August | 0 | 12 | 12 |
| 2018 July | 0 | 5 | 5 |
| 2018 June | 0 | 6 | 6 |
| 2018 May | 0 | 6 | 6 |
| 2018 April | 0 | 6 | 6 |
| 2018 March | 2 | 1 | 3 |
| 2018 February | 29 | 5 | 34 |
| 2018 January | 51 | 6 | 57 |
| 2017 December | 52 | 12 | 64 |
| 2017 November | 47 | 6 | 53 |
| 2017 October | 35 | 3 | 38 |
| 2017 September | 37 | 10 | 47 |
| 2017 August | 59 | 12 | 71 |
| 2017 July | 52 | 13 | 65 |
| 2017 June | 54 | 15 | 69 |
| 2017 May | 56 | 14 | 70 |
| 2017 April | 43 | 8 | 51 |
| 2017 March | 29 | 8 | 37 |
| 2017 February | 25 | 17 | 42 |
| 2017 January | 24 | 20 | 44 |
| 2016 December | 43 | 18 | 61 |
| 2016 November | 43 | 23 | 66 |
| 2016 October | 36 | 15 | 51 |
| 2016 September | 0 | 4 | 4 |
| 2016 August | 0 | 1 | 1 |
| 2016 July | 8 | 1 | 9 |
| 2016 June | 11 | 7 | 18 |
| 2016 May | 3 | 13 | 16 |
| 2016 April | 10 | 1 | 11 |
| 2016 March | 9 | 3 | 12 |
| 2016 February | 14 | 2 | 16 |
| 2016 January | 15 | 13 | 28 |
| 2015 December | 8 | 3 | 11 |
| 2015 November | 5 | 5 | 10 |
| 2015 October | 0 | 1 | 1 |
| 2015 September | 0 | 2 | 2 |
| 2015 August | 0 | 3 | 3 |
| 2015 July | 7 | 2 | 9 |
| 2015 June | 7 | 9 | 16 |
| 2015 May | 6 | 6 | 12 |
Show all
