Case and Research Letter
Cutaneous Sarcoid with Livedoid Changes in a Patient with Hashimoto's Thyroiditis
Sarcoidosis cutánea con cambios livedoides en un paciente con tiroiditis de Hashimoto
Read
3816
Timeswas read the article
1502
Total PDF
2314
Total HTML
Share statistics
array:23 [ "pii" => "S1578219016302955" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.07.016" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "1479" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:876-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 581 "formatos" => array:3 [ "EPUB" => 61 "HTML" => 366 "PDF" => 154 ] ] "Traduccion" => array:1 [ "en" => array:18 [ "pii" => "S0001731016302769" "issn" => "00017310" "doi" => "10.1016/j.ad.2016.07.011" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "1479" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:876-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 672 "formatos" => array:3 [ "EPUB" => 62 "HTML" => 315 "PDF" => 295 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Cutaneous Sarcoid with Livedoid Changes in a Patient with Hashimoto's Thyroiditis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "876" "paginaFinal" => "878" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoidosis cutánea con cambios livedoides en un paciente con tiroiditis de Hashimoto" ] ] "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" => 1287 "Ancho" => 1700 "Tamanyo" => 455000 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Reddish plaques on the thigh along with livedoid changes. (b) Histological features showing sarcoidal granuloma, which are immunoreactive for TNF-α (c) and IL-17 (d) (original magnification: b; ×400, c; ×200, d; ×200).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "T. Yamamoto, H. Okabe" "autores" => array:2 [ 0 => array:2 [ "nombre" => "T." "apellidos" => "Yamamoto" ] 1 => array:2 [ "nombre" => "H." "apellidos" => "Okabe" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219016302955" "doi" => "10.1016/j.adengl.2016.07.016" "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/S1578219016302955?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016302769?idApp=UINPBA000044" "url" => "/00017310/0000010700000010/v1_201611260105/S0001731016302769/v1_201611260105/en/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S1578219016302943" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.11.008" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "1458" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:874-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 577 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 369 "PDF" => 160 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Patient with disseminated tuberculosis and rare perianal involvement" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "874" "paginaFinal" => "876" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paciente con tuberculosis diseminada y un raro compromiso perianal" ] ] "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" => 1105 "Ancho" => 2664 "Tamanyo" => 283556 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray and high-resolution computed tomography showing widespread bilateral reticulonodular opacities.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Uribe-Bojanini, C. Santa-Vélez, A. Ruiz-Suarez, N. Buchely-Ibarra" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Uribe-Bojanini" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Santa-Vélez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Ruiz-Suarez" ] 3 => array:2 [ "nombre" => "N." "apellidos" => "Buchely-Ibarra" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0001731016301867" "doi" => "10.1016/j.ad.2016.05.018" "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/S0001731016301867?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302943?idApp=UINPBA000044" "url" => "/15782190/0000010700000010/v1_201611260103/S1578219016302943/v1_201611260103/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Cutaneous Sarcoid with Livedoid Changes in a Patient with Hashimoto's Thyroiditis" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "876" "paginaFinal" => "878" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "T. Yamamoto, H. Okabe" "autores" => array:2 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Yamamoto" "email" => array:1 [ 0 => "toyamade@fmu.ac.jp" ] "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" => "H." "apellidos" => "Okabe" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Fukushima Medical University, Fukushima, Japan" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Hoshi General Hospital, Fukushima, Japan" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoidosis cutánea con cambios livedoides en un paciente con tiroiditis de Hashimoto" ] ] "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" => 2145 "Ancho" => 2833 "Tamanyo" => 1030209 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Reddish plaques on the thigh along with livedoid changes. (b) Histological features showing sarcoidal granuloma, which are immunoreactive for TNF-α (c) and IL-17 (d) (original magnification: b; ×400, c; ×200, d; ×200).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Association of sarcoidosis and autoimmune thyroiditis is rare. We report a case of cutaneous sarcoid surrounded by livedo on the lower extremities in a patient with Hashimoto's thyroiditis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 72-year-old female visited the Department of Dermatology of Hoshi General Hospital, complaining of asymptomatic reddish eruptions on the lower extremities which appeared six months previously. She had Hashimoto's thyroiditis for several years, but had been followed without medications. Physical examination showed multiple reddish, infiltrative round and irregular-shaped, up to 4-cm sized plaques on the anterior aspects of the bilateral thighs and lower legs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). The erythematous plaques coalesced on the left thigh, and livedo was observed in the surroundings of the plaques on the thighs. Laboratory examination showed normal levels of angiotensin-converting enzyme (ACE) (13.6<span class="elsevierStyleHsp" style=""></span>U/L, normal: 7–25). Anti-thyroglobulin antibody showed high titers (86.8<span class="elsevierStyleHsp" style=""></span>IU/ml; normal <28), however, anti-thyroid peroxidase antibody, thyroid stimulating hormone, free T3 and T4 levels were within normal ranges. Chest X-ray did not reveal bilateral hilar lymphadenopathy. Computed tomography revealed a few lymph nodes within normal ranges and thyroid nodule. Ophthalmological examination denied uveitis. A tuberculin test revealed positive erythematous reaction sized 2-cm without induration. A skin biopsy taken from reddish plaque showed non-caseating granulomas with epithelioid cells throughout the dermis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). Periodic acid-Schiff (PAS) and Ziehl–Neelsen staining did not detect bacilli. Immunohistochemistry revealed a number of CD68-positive macrophages in the lesional skin. Tumor necrosis factor-α (TNF-α) and interleukin-17 (IL-17) positive cells were also detected densely (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>c and d). Elastica van Gieson stain showed that multiple sarcoidal granulomas were located around the vessels, but without fibrinoid degeneration.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Autoimmune thyroiditis is sometimes seen in association with sarcoidosis,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> and to date, several cases of co-occurrence of sarcoidosis and Hashimoto's thyroiditis have been reported. Isernet et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> reported that 10 out of 348 patients with sarcoidosis had autoimmune thyroiditis, and sarcoidosis preceded autoimmune thyroiditis in 9 cases. The diagnosis of autoimmune thyroiditis was made when sarcoidosis was in remission. Papadopoulos et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> reported that 13 patients had thyroid autoimmunity (6 with Hashimoto's thyroiditis, 2 with Graves’ disease and 5 with isolated positive thyroid serology) among a series of 78 patients with sarcoidosis. Nakamura et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> found 7 cases of Hashimoto's thyroiditis in a series of 62 patients with pulmonary sarcoidosis. Unfortunately, an open biopsy of thyroid nodule was not carried out to differentiate thyroid sarcoidosis in the present case. At present, sarcoidal lesions were not detected in other organs, <span class="elsevierStyleItalic">i.e.</span> lung or eyes. Moreover, a tuberculin test revealed positive reaction. Therefore, we consider that the patient developed cutaneous sarcoid only; however, we will carefully follow-up this patient whether symptoms of systemic sarcoidosis will appear in the future.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Macrophages play an important role in sarcoidal granuloma formation <span class="elsevierStyleItalic">via</span> several cytokines such as TNF-α and IL-1β. Several recent studies have reported the effectiveness of TNF-α inhibition for sarcoidosis. Our studies showed a number of CD163-positive macrophages surrounding the degenerated collagen in the dermis. In addition, strong expression of IL-17 and TNF-α was detected in the lesional skin of sarcoidosis. TNF-α activates Th17 cells leading IL-17 production, and recent studies have shown that IL-17 was abundantly detected in sarcoidal lesions, suggesting that Th17 cells induce granuloma formation by suppressing regulatory T-cells.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Recent findings suggest an important etiologic role of <span class="elsevierStyleItalic">Propionibacterium acnes</span> (<span class="elsevierStyleItalic">P. acnes</span>) in sarcoidosis. <span class="elsevierStyleItalic">P. acnes</span> induces IL-17 and interferon-γ,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> and is thus implicated to play a pathogenic role in sarcoidosis <span class="elsevierStyleItalic">via</span> Th1/Th17 cytokines.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally, livedo was seen around sarcoidal plaques on the bilateral thigh. To date, only a few cases have been presented with livedo in association with sarcoidosis.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7–9</span></a> A biopsy was taken from the sarcoidal plaque, but not from the surrounding livedo. However, histological examination showed granulomas around the vessels, which may induce livedo.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human subjects and animals in research</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human subjects and animals in research" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2145 "Ancho" => 2833 "Tamanyo" => 1030209 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Reddish plaques on the thigh along with livedoid changes. (b) Histological features showing sarcoidal granuloma, which are immunoreactive for TNF-α (c) and IL-17 (d) (original magnification: b; ×400, c; ×200, d; ×200).</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" => "Autoimmune thyroid disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Antonelli" 1 => "S.M. Ferrari" 2 => "A. Corrado" 3 => "A. Di Domenicantonio" 4 => "P. Fallahi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2014.10.016" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2015" "volumen" => "14" "paginaInicial" => "174" "paginaFinal" => "180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25461470" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis and autoimmune thyroid disease: a case series of ten patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V. Isern" 1 => "J. Lora-Tamayo" 2 => "O. Capdevila" 3 => "C. Villabona" 4 => "J. Mańá" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Sarcoidosis Vasc Diffuse Lung Dis" "fecha" => "2007" "volumen" => "24" "paginaInicial" => "148" "paginaFinal" => "152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18496986" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High frequency of endocrine autoimmunity in patients with sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.I. Papadopoulos" 1 => "Y. Hörnblad" 2 => "H. Liljebladh" 3 => "B. Hallengren" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Endocrinol" "fecha" => "1996" "volumen" => "134" "paginaInicial" => "331" "paginaFinal" => "336" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8616531" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High incidence of positive autoantibodies against thyroid peroxidase and thyroglobulin in patients with sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Nakamura" 1 => "R. Genma" 2 => "T. Mikami" 3 => "A. Kitahara" 4 => "H. Natsume" 5 => "S. Andoh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Endocrinol (Oxf)" "fecha" => "1997" "volumen" => "46" "paginaInicial" => "467" "paginaFinal" => "472" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased IL-17A expression in granulomas and in circulating memory T cells in sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Ten Berge" 1 => "M.S. Paats" 2 => "I.M. Bergen" 3 => "B. van den Blink" 4 => "H.C. Hoogsteden" 5 => "B.N. Lambrecht" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/ker316" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2012" "volumen" => "51" "paginaInicial" => "37" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22075064" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Propionibacterium acnes induces an IL-17 response in acne vulgaris that is regulated by vitamin A and vitamin D" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.W. Agak" 1 => "M. Qin" 2 => "J. Nobe" 3 => "M.H. Kim" 4 => "S.R. Krutzik" 5 => "G.R. Tristan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/jid.2013.334" "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "2014" "volumen" => "134" "paginaInicial" => "366" "paginaFinal" => "373" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23924903" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of sarcoidosis with livedo" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Hayashi" 1 => "A. Hatamochi" 2 => "Y. Hamasaki" 3 => "Y. Kitamura" 4 => "Y. Ishii" 5 => "T. Fukuda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2009.04123.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2009" "volumen" => "48" "paginaInicial" => "1217" "paginaFinal" => "1221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20064180" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythema nodosum-like cutaneous lesions of sarcoidosis showing livedoid changes in a patient with sarcoidosis and Sjögren's syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Takenoshita" 1 => "T. Yamamoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1684/ejd.2010.1034" "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2010" "volumen" => "20" "paginaInicial" => "640" "paginaFinal" => "641" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20610374" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of sarcoidosis presenting as livedo" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Shibama" 1 => "K. Igawa" 2 => "T. Munetsugu" 3 => "K. Fukuyama" 4 => "A. Nishizawa" 5 => "K. Takayama" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5021/ad.2014.26.6.773" "Revista" => array:6 [ "tituloSerie" => "Ann Dermatol" "fecha" => "2014" "volumen" => "26" "paginaInicial" => "773" "paginaFinal" => "774" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25473240" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000010/v1_201611260103/S1578219016302955/v1_201611260103/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/15782190/0000010700000010/v1_201611260103/S1578219016302955/v1_201611260103/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302955?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 10 | 14 |
| 2024 October | 65 | 35 | 100 |
| 2024 September | 66 | 18 | 84 |
| 2024 August | 85 | 42 | 127 |
| 2024 July | 70 | 25 | 95 |
| 2024 June | 68 | 32 | 100 |
| 2024 May | 75 | 29 | 104 |
| 2024 April | 55 | 25 | 80 |
| 2024 March | 60 | 15 | 75 |
| 2024 February | 36 | 36 | 72 |
| 2024 January | 48 | 28 | 76 |
| 2023 December | 51 | 20 | 71 |
| 2023 November | 45 | 37 | 82 |
| 2023 October | 43 | 15 | 58 |
| 2023 September | 50 | 28 | 78 |
| 2023 August | 34 | 17 | 51 |
| 2023 July | 29 | 31 | 60 |
| 2023 June | 39 | 21 | 60 |
| 2023 May | 48 | 19 | 67 |
| 2023 April | 29 | 21 | 50 |
| 2023 March | 90 | 20 | 110 |
| 2023 February | 54 | 24 | 78 |
| 2023 January | 22 | 31 | 53 |
| 2022 December | 38 | 37 | 75 |
| 2022 November | 22 | 19 | 41 |
| 2022 October | 20 | 16 | 36 |
| 2022 September | 24 | 28 | 52 |
| 2022 August | 18 | 23 | 41 |
| 2022 July | 21 | 23 | 44 |
| 2022 June | 13 | 17 | 30 |
| 2022 May | 24 | 27 | 51 |
| 2022 April | 26 | 20 | 46 |
| 2022 March | 27 | 31 | 58 |
| 2022 February | 17 | 12 | 29 |
| 2022 January | 32 | 25 | 57 |
| 2021 December | 22 | 25 | 47 |
| 2021 November | 27 | 40 | 67 |
| 2021 October | 30 | 54 | 84 |
| 2021 September | 19 | 40 | 59 |
| 2021 August | 21 | 28 | 49 |
| 2021 July | 14 | 15 | 29 |
| 2021 June | 20 | 26 | 46 |
| 2021 May | 22 | 27 | 49 |
| 2021 April | 41 | 52 | 93 |
| 2021 March | 59 | 23 | 82 |
| 2021 February | 28 | 23 | 51 |
| 2021 January | 19 | 17 | 36 |
| 2020 December | 14 | 12 | 26 |
| 2020 November | 19 | 15 | 34 |
| 2020 October | 9 | 3 | 12 |
| 2020 September | 24 | 10 | 34 |
| 2020 August | 14 | 12 | 26 |
| 2020 July | 27 | 15 | 42 |
| 2020 June | 22 | 18 | 40 |
| 2020 May | 12 | 11 | 23 |
| 2020 April | 20 | 18 | 38 |
| 2020 March | 14 | 7 | 21 |
| 2020 February | 3 | 0 | 3 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 8 | 0 | 8 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 8 | 0 | 8 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 7 | 0 | 7 |
| 2019 April | 4 | 4 | 8 |
| 2019 February | 4 | 0 | 4 |
| 2018 December | 4 | 0 | 4 |
| 2018 November | 5 | 0 | 5 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 2 | 0 | 2 |
| 2018 February | 14 | 1 | 15 |
| 2018 January | 19 | 9 | 28 |
| 2017 December | 23 | 7 | 30 |
| 2017 November | 20 | 5 | 25 |
| 2017 October | 19 | 5 | 24 |
| 2017 September | 23 | 4 | 27 |
| 2017 August | 25 | 5 | 30 |
| 2017 July | 11 | 6 | 17 |
| 2017 June | 19 | 9 | 28 |
| 2017 May | 18 | 4 | 22 |
| 2017 April | 20 | 15 | 35 |
| 2017 March | 15 | 21 | 36 |
| 2017 February | 14 | 6 | 20 |
| 2017 January | 6 | 16 | 22 |
| 2016 December | 41 | 27 | 68 |
| 2016 November | 15 | 10 | 25 |
Show all
