Case and Research Letters
Dyshidrotic Eczema Secondary to Intravenous Immunoglobulin Infusion: A Report of 2 Cases
Eccema dishidrótico secundario a la infusión de inmunoglobulinas intravenosas: presentación de 2 casos
A.A. Garrido-Ríos
, C. Martínez-Morán, J. Borbujo
Corresponding author
Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
Read
10435
Timeswas read the article
2497
Total PDF
7938
Total HTML
Share statistics
array:24 [ "pii" => "S1578219016300270" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.03.013" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1313" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:431-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 848 "formatos" => array:3 [ "EPUB" => 54 "HTML" => 622 "PDF" => 172 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731015005141" "issn" => "00017310" "doi" => "10.1016/j.ad.2015.09.018" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1313" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:431-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 314 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 260 "PDF" => 52 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Eccema dishidrótico secundario a la infusión de inmunoglobulinas intravenosas: presentación de 2 casos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "431" "paginaFinal" => "433" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Dyshydrotic Eczema Secondary to Intravenous Immunoglobulin Infusion: A Report of 2 Cases" ] ] "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" => 1313 "Ancho" => 1583 "Tamanyo" => 408217 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lesiones vesiculosas sobre base eritematosa en la palma de la mano del primer paciente.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.A. Garrido-Ríos, C. Martínez-Morán, J. Borbujo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A.A." "apellidos" => "Garrido-Ríos" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Martínez-Morán" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Borbujo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219016300270" "doi" => "10.1016/j.adengl.2016.03.013" "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/S1578219016300270?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015005141?idApp=UINPBA000044" "url" => "/00017310/0000010700000005/v1_201605260143/S0001731015005141/v1_201605260143/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219016300282" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.03.014" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1320" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:433-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 937 "formatos" => array:3 [ "EPUB" => 51 "HTML" => 694 "PDF" => 192 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Self-healing Collodion Baby: A New Mutation in the <span class="elsevierStyleItalic">ALOX12B</span> Gene" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "433" "paginaFinal" => "435" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bebé colodión autorresolutivo: nueva mutación en el gen ALOX12B" ] ] "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" => 1201 "Ancho" => 1600 "Tamanyo" => 387266 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Shiny membrane covering practically the whole body surface like a suit of armor. B, Ectropion, eclabium, and clawed-hand deformity. C, Retraction of the auricle of the left ear and view of the membrane over the back with a central fissure in the dorsal region. D, Peeling of the whole membrane in large sheets.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Santesteban Muruzábal, A. Larumbe Irurzun, I. Yanguas Bayona, M.A. Ramos Arroyo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Santesteban Muruzábal" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Larumbe Irurzun" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Yanguas Bayona" ] 3 => array:2 [ "nombre" => "M.A." "apellidos" => "Ramos Arroyo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015005591" "doi" => "10.1016/j.ad.2015.10.014" "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/S0001731015005591?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300282?idApp=UINPBA000044" "url" => "/15782190/0000010700000005/v2_201703310310/S1578219016300282/v2_201703310310/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016300373" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.03.019" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1293" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2016;107:430" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1505 "formatos" => array:3 [ "EPUB" => 49 "HTML" => 1287 "PDF" => 169 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>" "titulo" => "Retiform Purpura Associated With Protein S Deficiency" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "430" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Púrpura retiforme asociada a déficit de proteína S" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 816 "Ancho" => 975 "Tamanyo" => 188402 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Agudo-García, F. Terrasa-Sagristà, E. Parera-Amer" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Agudo-García" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Terrasa-Sagristà" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Parera-Amer" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015004895" "doi" => "10.1016/j.ad.2015.04.024" "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/S0001731015004895?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300373?idApp=UINPBA000044" "url" => "/15782190/0000010700000005/v2_201703310310/S1578219016300373/v2_201703310310/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Dyshidrotic Eczema Secondary to Intravenous Immunoglobulin Infusion: A Report of 2 Cases" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Letter to the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "431" "paginaFinal" => "433" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.A. Garrido-Ríos, C. Martínez-Morán, J. Borbujo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A.A." "apellidos" => "Garrido-Ríos" "email" => array:1 [ 0 => "natachagarrido@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Martínez-Morán" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Borbujo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eccema dishidrótico secundario a la infusión de inmunoglobulinas intravenosas: presentación de 2 casos" ] ] "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" => 657 "Ancho" => 986 "Tamanyo" => 91376 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Vesicular lesions on an erythematous base on the palm of the second patient.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present 2 cases of dyshidrotic eczema secondary to intravenous immunoglobulin infusion. The first patient was a 58-year-old man who had been diagnosed with Guillain-Barré syndrome after presenting with sock-like paresthesia, unstable gait, and diminished tendon reflexes. The patient was treated with intravenous immunoglobulin, and his symptoms gradually improved. Ten days after admission, he began to develop asymptomatic lesions on his palms and soles.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed punctate vesicular lesions filled with clear fluid on an erythematous base located bilaterally on the palms and soles (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Some of the vesicular lesions were purpuric in appearance and filled with blood, especially in dependent parts of the body (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). No mucosal involvement or lesions at other sites were observed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology revealed an epidermis with psoriasiform hyperplasia, lymphocytic and erythrocytic exocytosis, and extensive spongiosis with formation of large subcorneal vesicles. The underlying dermis showed a moderate superficial perivascular lymphohistiocytic inflammatory infiltrate accompanied by blood extravasation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The second patient was a 67-year-old man whose personal history included removal of pleomorphous sarcoma on the right pectoral muscle and treatment with radiotherapy and chemotherapy. He was admitted 8 months after surgery for assessment of ataxia. During admission, and given the gradual worsening of his condition, he received intravenous immunoglobulin, and his symptoms partially resolved. A dermatological evaluation was ordered for the asymptomatic skin lesions, which were very similar to those of the first patient: vesicular lesions filled with clear fluid on an erythematous base located on the palms and soles. Histopathology findings were very similar to those of the first patient (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">We diagnosed both patients with dyshidrotic eczema secondary to treatment with intravenous immunoglobulin.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The lesions resolved in both cases with topical corticosteroids, although they reappeared in the first patient during the second cycle of treatment.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Intravenous immunoglobulins are isolated from plasma obtained from between 1000 and 100 000 persons. They are subsequently purified to eliminate or inactivate infectious agents and prevent the formation of aggregates.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> They have been approved by the European Medicines Agency for the following indications: primary immunodeficiency syndromes with impaired antibody production; hypogammaglobulinemia and recurrent bacterial infections in patients with chronic lymphocytic leukemia in which antibiotic prophylaxis has not been successful; hypogammaglobulinemia and recurrent bacterial infection in patients with plateau-phase multiple myeloma who did not respond to pneumococcal vaccination; hypogammaglobulinemia in patients who undergo allogenic stem cell transplantation; congenital AIDS with recurrent bacterial infection; primary immune thrombocytopenia; patients at high risk of bleeding; patients undergoing surgery to correct their platelet count; Guillain-Barré syndrome; and Kawasaki disease.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> They are used off-label in numerous hematologic, neurologic, rheumatologic, infectious, and dermatologic conditions.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Intravenous immunoglobulin has a good safety profile, and most adverse effects are associated with administration. The adverse effects, which are immediate, mild, and transient, consist of flulike symptoms that include headache, flushing, general malaise, chest tightness, fever, chills, myalgia, fatigue, dyspnea, back pain, nausea and vomiting, diarrhea, changes in blood pressure, and tachycardia. The most severe adverse effects are usually late in onset and manifest as thromboembolic events and renal, neurologic, and/or hematologic toxicity. Cutaneous adverse effects appear in 0.4%-6% of patients in the form of transient urticaria or maculopapular rash, palmar pruritus, hair loss, erythema multiforme, erythematous purpuric rash, petechiae on the limbs, ulceration of the oral mucosa, transient epidermolysis bullosa, lichenoid eruptions, and Baboon syndrome.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Eczema is rarely associated with administration of intravenous immunoglobulin. In their review of the literature, Gerstenblith et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> found 64 patients with eczematous reactions associated with intravenous immunoglobulin. The most common findings were the presence of multiple punctate erythematous vesicles grouped together on the palms and soles. Histopathology revealed the spongiotic loculated vesicles that are typical of dyshidrosis and a perivascular infiltrate composed of lymphocytes and eosinophils, as well as lymphocytic exocytosis in the epidermis. Overall, 62.5% of patients had lesions of dyshidrotic eczema on the palms and soles or on the palms and soles and at least 1 other affected site. Most patients received intravenous immunoglobulin for neurologic diseases. Almost all patients responded well to topical corticosteroids or did not require treatment, although treatment with oral corticosteroids was occasionally necessary. The eczematous reaction improved in all the cases reported, although in 1 case, itching persisted for months after suspending intravenous immunoglobulins. Despite these findings, therapy was suspended because of the eczematous reactions. No clear mechanism has been identified that might explain the association with eczema,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> although some authors suggest a hypersensitivity reaction to the drug or vehicle that has not been demonstrated with patch testing or prick testing.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the first patient, we thought that the skin lesions were gloves and socks syndrome, given that the histopathology findings were consistent with this syndrome and that this and Guillain-Barré syndrome can be triggered by common infectious agents such as parvovirus, <span class="elsevierStyleItalic">Mycoplasma</span>, Epstein-Barr virus, and cytomegalovirus<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6,7</span></a>; however, the results of serology testing to various pathogens were repeatedly negative.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Other diseases that can be taken into consideration with this type of lesion include palmoplantar pustular psoriasis, allergic contact dermatitis, dyshidrosiform tinea, scabies, id reaction, herpes simplex, and other bullous diseases such as pemphigus, pemphigoid, and epidermolysis bullosa.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As this was a first episode of asymptomatic lesions associated in time with infusion of intravenous immunoglobulin (8 and 5 days, respectively) and reappearance of the lesions during the second treatment cycle in the first patient, we were able to confirm the diagnosis.</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: Garrido-Ríos AA, Martínez-Morán C, Borbujo J. Eccema dishidrótico secundario a la infusión de inmunoglobulinas intravenosas: presentación de 2 casos. Actas Dermosifiliogr. 2016;107:431–433.</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" => 788 "Ancho" => 950 "Tamanyo" => 174941 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vesicular lesions on an erythematous base on the palm of the first 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" => 657 "Ancho" => 986 "Tamanyo" => 95410 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Vesicular blood-filled lesions on the sole of the first patient.</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" => 657 "Ancho" => 986 "Tamanyo" => 91376 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Vesicular lesions on an erythematous base on the palm of the second patient.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of intravenous immunoglobulin G (IVIG)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.J. Looney" 1 => "J. Huggins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.beha.2005.01.032" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Haematol" "fecha" => "2006" "volumen" => "19" "paginaInicial" => "3" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16377538" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "[consultado 10 Sept 2015] Available at: <a href="http://www.ema.europa.eu/docs/es_ES/document_library/EPAR_-_Product_Information/human/000781/WC500023473.pdf">http://www.ema.europa.eu/docs/es_ES/document_library/EPAR_-_Product_Information/human/000781/WC500023473.pdf</a>" ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous immunoglobulin: Adverse effects and safe administration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Orbach" 1 => "U. Katz" 2 => "Y. Sherer" 3 => "Y. Shoenfeld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1385/CRIAI:29:3:173" "Revista" => array:6 [ "tituloSerie" => "Clin Rev Allergy Immunol" "fecha" => "2005" "volumen" => "29" "paginaInicial" => "173" "paginaFinal" => "184" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16391392" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pompholyx and eczematous reactions associated with intravenous immunoglobulin therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.R. Gerstenblith" 1 => "A.K. Antony" 2 => "J.M. Junkins-Hopkins" 3 => "R. Abuay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2010.12.034" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2012" "volumen" => "66" "paginaInicial" => "312" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21601310" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dyshidrosis: Epidemiology, clinical characteristics, and therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.M. Lofgren" 1 => "E.M. Warshaw" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatitis" "fecha" => "2006" "volumen" => "17" "paginaInicial" => "165" "paginaFinal" => "181" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17150166" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mycoplasma pneumoniae infection presenting as bullous papular purpuric gloves and socks syndrome: Novel association and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.M. Pemira" 1 => "R.W. Tolan Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Pediatr (Phila)" "fecha" => "2011" "volumen" => "50" "paginaInicial" => "1140" "paginaFinal" => "1143" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "ID793024" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An update in Guillain-Barré syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.B. Winer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Autoimmune Dis" "fecha" => "2014" "volumen" => "2014" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000005/v2_201703310310/S1578219016300270/v2_201703310310/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/15782190/0000010700000005/v2_201703310310/S1578219016300270/v2_201703310310/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300270?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 13 | 25 |
| 2024 October | 113 | 63 | 176 |
| 2024 September | 125 | 46 | 171 |
| 2024 August | 159 | 74 | 233 |
| 2024 July | 174 | 55 | 229 |
| 2024 June | 150 | 65 | 215 |
| 2024 May | 119 | 49 | 168 |
| 2024 April | 95 | 37 | 132 |
| 2024 March | 106 | 47 | 153 |
| 2024 February | 122 | 46 | 168 |
| 2024 January | 105 | 48 | 153 |
| 2023 December | 125 | 32 | 157 |
| 2023 November | 146 | 41 | 187 |
| 2023 October | 200 | 38 | 238 |
| 2023 September | 143 | 45 | 188 |
| 2023 August | 97 | 32 | 129 |
| 2023 July | 179 | 79 | 258 |
| 2023 June | 106 | 37 | 143 |
| 2023 May | 134 | 44 | 178 |
| 2023 April | 115 | 40 | 155 |
| 2023 March | 135 | 36 | 171 |
| 2023 February | 144 | 40 | 184 |
| 2023 January | 116 | 41 | 157 |
| 2022 December | 132 | 44 | 176 |
| 2022 November | 101 | 56 | 157 |
| 2022 October | 85 | 40 | 125 |
| 2022 September | 105 | 56 | 161 |
| 2022 August | 46 | 50 | 96 |
| 2022 July | 69 | 43 | 112 |
| 2022 June | 60 | 34 | 94 |
| 2022 May | 210 | 49 | 259 |
| 2022 April | 205 | 67 | 272 |
| 2022 March | 228 | 59 | 287 |
| 2022 February | 241 | 41 | 282 |
| 2022 January | 233 | 48 | 281 |
| 2021 December | 178 | 63 | 241 |
| 2021 November | 179 | 50 | 229 |
| 2021 October | 156 | 58 | 214 |
| 2021 September | 136 | 60 | 196 |
| 2021 August | 122 | 33 | 155 |
| 2021 July | 116 | 32 | 148 |
| 2021 June | 139 | 26 | 165 |
| 2021 May | 149 | 32 | 181 |
| 2021 April | 373 | 43 | 416 |
| 2021 March | 214 | 23 | 237 |
| 2021 February | 162 | 32 | 194 |
| 2021 January | 108 | 26 | 134 |
| 2020 December | 119 | 18 | 137 |
| 2020 November | 111 | 25 | 136 |
| 2020 October | 72 | 9 | 81 |
| 2020 September | 98 | 19 | 117 |
| 2020 August | 48 | 16 | 64 |
| 2020 July | 59 | 21 | 80 |
| 2020 June | 44 | 35 | 79 |
| 2020 May | 32 | 27 | 59 |
| 2020 April | 27 | 22 | 49 |
| 2020 March | 38 | 18 | 56 |
| 2020 February | 1 | 2 | 3 |
| 2019 December | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 May | 5 | 1 | 6 |
| 2019 April | 0 | 1 | 1 |
| 2019 March | 2 | 3 | 5 |
| 2019 February | 3 | 0 | 3 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 4 | 0 | 4 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 5 | 0 | 5 |
| 2018 September | 4 | 0 | 4 |
| 2018 February | 35 | 5 | 40 |
| 2018 January | 56 | 8 | 64 |
| 2017 December | 68 | 8 | 76 |
| 2017 November | 53 | 5 | 58 |
| 2017 October | 33 | 8 | 41 |
| 2017 September | 22 | 6 | 28 |
| 2017 August | 31 | 3 | 34 |
| 2017 July | 25 | 10 | 35 |
| 2017 June | 31 | 11 | 42 |
| 2017 May | 50 | 2 | 52 |
| 2017 April | 22 | 5 | 27 |
| 2017 March | 31 | 3 | 34 |
| 2017 February | 22 | 10 | 32 |
| 2017 January | 22 | 7 | 29 |
| 2016 December | 31 | 16 | 47 |
| 2016 November | 32 | 28 | 60 |
| 2016 October | 23 | 27 | 50 |
| 2016 June | 0 | 5 | 5 |
Show all
