Case and Research Letters
Erythema Multiforme-Like Bullous Pemphigoid
Penfigoide ampolloso tipo eritema multiforme
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A, Lesion with a 3-zone pattern. Hematoxylin and eosin (H&E), low-power view. B and C, Proliferation of atypical melanocytes at the dermoepidermal junction with an area of scarring, nests of atypical melanocytes, and a congenital-type residual nevus both peripheral and deep to the scar. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×100. D, Scattered areas of pagetoid spread of melanocytic cells in other areas of the epidermis. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×400.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "U. Floristán Muruzábal, F.J. Pinedo Moraleda, R. Gamo Villegas, J.L. López Estebaranz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "U." "apellidos" => "Floristán Muruzábal" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "Pinedo Moraleda" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Gamo Villegas" ] 3 => array:2 [ "nombre" => "J.L." 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Imbernón-Moya, A. Aguilar, F. Burgos, M.Á. Gallego" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Imbernón-Moya" "email" => array:1 [ 0 => "adrian_imber88@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Aguilar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Burgos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M.Á." "apellidos" => "Gallego" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Penfigoide ampolloso tipo eritema multiforme" ] ] "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" => 1199 "Ancho" => 1601 "Tamanyo" => 687912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Vacuolization of the basal layer of the epidermis with no clear evidence of vesicles or blisters, and the presence of a superficial and deep dermal inflammatory infiltrate with lymphocytes and occasional eosinophils. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×20. B, Subepidermal blister containing fibrin and abundant eosinophils, and a dermal infiltrate of lymphocytes and eosinophils. Marked subepidermal edema is observed close to the blister with early separation of the dermoepidermal junction. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×20.<span class="elsevierStyleHsp" style=""></span>C, Positive direct immunofluorescence with linear deposits of immunoglobulin G and C3 at the dermoepidermal junction.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Bullous pemphigoid (BP) is the most common chronic autoimmune subepidermal bullous dermatosis, occurring mainly in the elderly. It is characterized clinically by a pruritic polymorphous skin rash that typically arises on the abdomen, the flexor surfaces of the limbs, the neck, axillas, and groin. Initially the lesions are often excoriated, erythematous, eczematous, and/or urticarial. Blisters usually then develop on normal or erythematous skin, giving rise to crusted erosive areas that heal without scarring. The diagnosis is confirmed by the demonstration of deposits of immunoglobulin (Ig) G or of the C3 component of complement on the epidermal basement membrane, and the presence in the serum of circulating IgG antibasement membrane zone antibodies against antigens BP-180 and BP-230. Numerous variants of BP have been described, with a broad spectrum of clinical manifestations.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 32-year-old woman, with skin phototype <span class="elsevierStyleSmallCaps">VI</span>, with no personal or family history of interest, was seen in dermatology outpatients for the appearance of a highly pruritic, widespread skin rash that had developed 3 weeks earlier. The patient was not taking any medication or using topical products, had not been sunbathing, and reported no associated systemic symptoms.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On physical examination, she presented a good general state of health. Examination of the skin revealed multiple well-defined, confluent, edematous erythematous plaques with centrifugal growth, with tense peripheral vesicles and blisters containing a clear fluid, producing a polycyclic, annular morphology (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1, A and B</a>). The skin lesions affected the face, neck, trunk, and limbs, including the dorsum of the hands and feet. No lesions were observed on the palms, soles, mucosas, nails, or scalp. The Nikolsky and Asboe-Hansen signs were negative.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Laboratory tests including routine biochemistry, urinalysis, coagulation studies, antinuclear antibodies, antitransglutaminase antibodies, serum electrophoresis, and immunoglobulin and complement levels were normal or negative. The only findings of interest were a white cell count of 20<span class="elsevierStyleHsp" style=""></span>000 cells/μL with eosinophilia of 6000 cells/μl, and elevation of the erythrocyte sedimentation rate (35<span class="elsevierStyleHsp" style=""></span>mm in the first hour). Serology for syphilis, hepatitis B and C viruses, and HIV was negative. The Mantoux test was negative. Chest x-ray showed no significant changes of interest.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A skin biopsy taken from an urticarial plaque showed a lymphocytic and eosinophilic dermal infiltrate with focal changes at the dermoepidermal interface (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2A</a>). A biopsy was also taken from a blister, revealing a subepidermal blister associated with a lymphocytic and eosinophilic dermal infiltrate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2B</a>). Direct immunofluorescence of healthy perilesional skin was positive, showing linear deposits of IgG and C3 at the dermoepidermal junction with a U-serrated pattern (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2C</a>). Indirect immunofluorescence on 1<span class="elsevierStyleHsp" style=""></span>M sodium chloride-separated skin showed the presence of circulating antibasement membrane zone antibodies bound on the epidermal side, at a titer of 1:80. Autoimmune studies were positive for circulating antibasement membrane antibodies against antigens BP-180 and BP-230 detected using the immunoblot technique on the patient's serum mixed with human epidermal extracts. Other antibodies studied (Sm, RNP, Ro, La, Scl-70, Jo-1, DNAd, antidesmogleins, collagen <span class="elsevierStyleSmallCaps">VII</span>, antidesmocollins) were negative.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">With a diagnosis of BP, treatment was initiated with oral prednisone, 90<span class="elsevierStyleHsp" style=""></span>mg/d (1.5<span class="elsevierStyleHsp" style=""></span>mg/kg/d), combined with azathioprine, 100<span class="elsevierStyleHsp" style=""></span>mg/d. Two weeks after starting treatment, the patient presented a progressive clinical improvement, and the dose of prednisone was gradually reduced. At the 6-month follow-up, the patient was stable, with no clinical recurrence, and remained on treatment with prednisone, 20<span class="elsevierStyleHsp" style=""></span>mg/d, and azathioprine, 100<span class="elsevierStyleHsp" style=""></span>mg/d; residual postinflammatory hyperpigmentation and milia-like cysts were observed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The cutaneous manifestations of BP can be atypical and highly polymorphous, and may or may not include the tense blisters characteristic of this entity. A number of atypical presentations have been described<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–3</span></a>: nonbullous, papular, eczematous, nodular, vesicular, annular erythema-like, erythema multiforme-like, erythrodermic, dyshydrosiform, vegetative, lichen planus pemphogoides, infantile, physical agent-induced, drug-induced, and localized (pretibial, vulvar, peristomal, umbilical, postradiotherapy, paralyzed-limb).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Erythema multiforme-like BP is a rare variant, with only 8 cases reported in the literature (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>),<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4–9</span></a> including 5 women and 3 men aged between 16 and 80 years. Suspected triggering factors include orf virus infection, furosemide, citalopram, thioridazine, flupentixol, amoxicillin, and penicillin. Lesions have been most common on the trunk and flexor surfaces of the limbs, although they can arise on any area of skin, including the palms and soles and the mucosas. The clinical findings in all cases included manifestations of erythema multiforme and bullous pemphigoid, and the diagnosis was confirmed by the immunopathology findings.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Our case was unusual, with early cutaneous manifestations suggestive of erythema multiforme, with centrifugally enlarging erythematous plaques on acral areas and on the extensor surfaces of the limbs, associated with focal histologic changes at the interface and subepidermal edema.</p><p id="par0050" class="elsevierStylePara elsevierViewall">BP must be considered in the differential diagnosis in patients with a diffuse erythema multiforme-like skin rash who develop erythematous or urticarial plaques with peripheral blisters, producing an annular or polycyclic morphology. A high level of clinical and histologic suspicion is required. The diagnosis is confirmed by positive direct and indirect immunofluorescence.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–3</span></a></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: Imbernón-Moya A, Aguilar A, Burgos F, Gallego MÁ. Penfigoide ampolloso tipo eritema multiforme. Actas Dermosifiliogr. 2016;107:690–692.</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" => 1224 "Ancho" => 800 "Tamanyo" => 180636 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Annular and polycyclic erythematous plaques with tense peripheral blisters on both thighs. B, Detail of the same lesions.</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" => 1199 "Ancho" => 1601 "Tamanyo" => 687912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Vacuolization of the basal layer of the epidermis with no clear evidence of vesicles or blisters, and the presence of a superficial and deep dermal inflammatory infiltrate with lymphocytes and occasional eosinophils. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×20. B, Subepidermal blister containing fibrin and abundant eosinophils, and a dermal infiltrate of lymphocytes and eosinophils. Marked subepidermal edema is observed close to the blister with early separation of the dermoepidermal junction. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×20.<span class="elsevierStyleHsp" style=""></span>C, Positive direct immunofluorescence with linear deposits of immunoglobulin G and C3 at the dermoepidermal junction.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age, y \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Suspected Etiologic Factor \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site of the Lesions \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mucosal Involvement \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Involvement of the Palms and Soles \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alian et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orf virus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Trunk, limbs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Park et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amlodipine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Trunk, limbs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hirano et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Furosemide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Face, neck, flexor surface of the limbs, trunk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hayakawa and Shiohara<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Extensor surface of the limbs, back, buttocks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mehravaran et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Citalopram<br>Thioridazine<br>Flupentixol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Flexor surface of the limbs, neckline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Alcalay et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amoxicillin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Face, neck, trunk, limbs</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Yes (oral, nasal, anogenital, ocular)</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Yes</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Penicillin G procaine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Penicillin \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1390652.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Description of the Published Cases of Erythema Multiforme-like Bullous Pemphigoid.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pemphigoid Group" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Bernard" 1 => "L. Borradori" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Dermatology" "paginaInicial" => "475" "paginaFinal" => "482" "edicion" => "3rd ed." "serieFecha" => "2012" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical presentations of bullous pemphigoid: Clinical and immunopathological aspects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Cozzani" 1 => "G. Gasparini" 2 => "M. Burlando" 3 => "F. Drago" 4 => "A. Parodi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2015.01.006" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2015" "volumen" => "14" "paginaInicial" => "438" "paginaFinal" => "445" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25617817" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bullous pemphigoid: From the clinic to the bench" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Di Zenzo" 1 => "R. Della Torre" 2 => "G. Zambruno" 3 => "L. Borradori" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2011.03.005" "Revista" => array:6 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "3" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22137222" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of orf disease complicated with erythema multiforme and bullous pemphigoid-like eruptions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Alian" 1 => "F. Ahangarkani" 2 => "S. Arabsheybani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2015/105484" "Revista" => array:6 [ "tituloSerie" => "Case Rep Infect Dis" "fecha" => "2015" "volumen" => "2015" "paginaInicial" => "105484" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26294986" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283806015879" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Amlodipine-associated bullous pemphigoid with erythema multiforme-likeclinical features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.Y. Park" 1 => "B.J. Kim" 2 => "M.N. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2009.04417.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2011" "volumen" => "50" "paginaInicial" => "637" "paginaFinal" => "639" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21506992" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythema multiforme-like bullous pemphigoid associated with furosemide" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.A. Hirano" 1 => "A.R. Mason" 2 => "V.M. Harvey" 3 => "A.F. Hood" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Clin Exp Dermatol Res" "fecha" => "2011" "volumen" => "2" "paginaInicial" => "123" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical bullous disease showing features of both erythema multiforme and bullous pemhigoid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Hayakawa" 1 => "T. Shiohara" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "2002" "volumen" => "82" "paginaInicial" => "196" "paginaFinal" => "199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12353711" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug-induced erythema multiforme-like bullous pemphigoid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Mehravaran" 1 => "R. Gyulai" 2 => "S. Husz" 3 => "A. Dobozy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "1999" "volumen" => "79" "paginaInicial" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10384926" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bullous pemphigoid mimicking bullous erythema multiforme: An untoward side effect of penicillins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Alcalay" 1 => "M. David" 2 => "A. Ingber" 3 => "B. Hazaz" 4 => "M. Sandbank" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1988" "volumen" => "18" "paginaInicial" => "345" "paginaFinal" => "349" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2964460" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000008/v2_201704100057/S1578219016301585/v2_201704100057/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/15782190/0000010700000008/v2_201704100057/S1578219016301585/v2_201704100057/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016301585?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 19 | 10 | 29 |
| 2024 October | 241 | 58 | 299 |
| 2024 September | 257 | 54 | 311 |
| 2024 August | 264 | 82 | 346 |
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| 2024 May | 222 | 55 | 277 |
| 2024 April | 192 | 40 | 232 |
| 2024 March | 245 | 41 | 286 |
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| 2023 December | 176 | 26 | 202 |
| 2023 November | 198 | 40 | 238 |
| 2023 October | 192 | 22 | 214 |
| 2023 September | 216 | 36 | 252 |
| 2023 August | 159 | 26 | 185 |
| 2023 July | 172 | 53 | 225 |
| 2023 June | 149 | 41 | 190 |
| 2023 May | 182 | 38 | 220 |
| 2023 April | 208 | 37 | 245 |
| 2023 March | 156 | 34 | 190 |
| 2023 February | 125 | 31 | 156 |
| 2023 January | 79 | 43 | 122 |
| 2022 December | 86 | 58 | 144 |
| 2022 November | 46 | 28 | 74 |
| 2022 October | 29 | 27 | 56 |
| 2022 September | 53 | 49 | 102 |
| 2022 August | 32 | 46 | 78 |
| 2022 July | 36 | 53 | 89 |
| 2022 June | 34 | 28 | 62 |
| 2022 May | 119 | 49 | 168 |
| 2022 April | 152 | 45 | 197 |
| 2022 March | 141 | 59 | 200 |
| 2022 February | 138 | 32 | 170 |
| 2022 January | 150 | 41 | 191 |
| 2021 December | 123 | 50 | 173 |
| 2021 November | 105 | 49 | 154 |
| 2021 October | 124 | 54 | 178 |
| 2021 September | 142 | 59 | 201 |
| 2021 August | 140 | 38 | 178 |
| 2021 July | 92 | 29 | 121 |
| 2021 June | 131 | 34 | 165 |
| 2021 May | 122 | 51 | 173 |
| 2021 April | 284 | 47 | 331 |
| 2021 March | 166 | 29 | 195 |
| 2021 February | 149 | 39 | 188 |
| 2021 January | 108 | 20 | 128 |
| 2020 December | 83 | 23 | 106 |
| 2020 November | 81 | 20 | 101 |
| 2020 October | 61 | 21 | 82 |
| 2020 September | 54 | 26 | 80 |
| 2020 August | 67 | 13 | 80 |
| 2020 July | 69 | 17 | 86 |
| 2020 June | 64 | 43 | 107 |
| 2020 May | 63 | 21 | 84 |
| 2020 April | 41 | 15 | 56 |
| 2020 March | 43 | 20 | 63 |
| 2020 February | 6 | 0 | 6 |
| 2020 January | 3 | 0 | 3 |
| 2019 December | 10 | 0 | 10 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 6 | 0 | 6 |
| 2019 August | 5 | 0 | 5 |
| 2019 July | 7 | 0 | 7 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 10 | 0 | 10 |
| 2019 April | 20 | 5 | 25 |
| 2019 March | 7 | 0 | 7 |
| 2019 February | 1 | 0 | 1 |
| 2019 January | 11 | 0 | 11 |
| 2018 December | 4 | 0 | 4 |
| 2018 November | 4 | 0 | 4 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 2 | 0 | 2 |
| 2018 February | 22 | 2 | 24 |
| 2018 January | 55 | 10 | 65 |
| 2017 December | 49 | 13 | 62 |
| 2017 November | 54 | 11 | 65 |
| 2017 October | 42 | 13 | 55 |
| 2017 September | 29 | 10 | 39 |
| 2017 August | 23 | 8 | 31 |
| 2017 July | 28 | 13 | 41 |
| 2017 June | 46 | 12 | 58 |
| 2017 May | 37 | 15 | 52 |
| 2017 April | 35 | 8 | 43 |
| 2017 March | 25 | 18 | 43 |
| 2017 February | 23 | 13 | 36 |
| 2017 January | 15 | 10 | 25 |
| 2016 December | 22 | 18 | 40 |
| 2016 November | 35 | 26 | 61 |
| 2016 October | 82 | 32 | 114 |
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