Case and Research Letter
Giant periurethral condyloma acuminata in a 2-year-old girl: Successful treatment with carbon dioxide laser
Condiloma acuminado periuretral gigante en niña de 2 años: tratamiento exitoso con láser de dióxido de carbono
X. Calderón-Castrat
, S. Blanco, J.C. Santos-Durán, M. Roncero-Riesco
Corresponding author
Department of Dermatology, University Hospital of Salamanca, Spain
Read
6778
Timeswas read the article
1862
Total PDF
4916
Total HTML
Share statistics
array:23 [ "pii" => "S1578219017301178" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.10.009" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1536" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:385-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 400 "formatos" => array:3 [ "EPUB" => 38 "HTML" => 275 "PDF" => 87 ] ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S0001731016303520" "issn" => "00017310" "doi" => "10.1016/j.ad.2016.10.002" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1536" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:385-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 566 "formatos" => array:3 [ "EPUB" => 60 "HTML" => 303 "PDF" => 203 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Giant periurethral condyloma acuminata in a 2-year-old girl: Successful treatment with carbon dioxide laser" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "385" "paginaFinal" => "387" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Condiloma acuminado periuretral gigante en niña de 2 años: tratamiento exitoso con láser de dióxido de carbono" ] ] "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" => 1304 "Ancho" => 2500 "Tamanyo" => 462629 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Multiple vestibular and vulvar condyloma acuminata. (B) 13-month follow-up post-CO<span class="elsevierStyleInf">2</span> laser surgery of anogenital condyloma acuminata.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "X. Calderón-Castrat, S. Blanco, J.C. Santos-Durán, M. Roncero-Riesco" "autores" => array:4 [ 0 => array:2 [ "nombre" => "X." "apellidos" => "Calderón-Castrat" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Blanco" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Santos-Durán" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Roncero-Riesco" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219017301178" "doi" => "10.1016/j.adengl.2016.10.009" "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/S1578219017301178?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016303520?idApp=UINPBA000044" "url" => "/00017310/0000010800000004/v2_201705020105/S0001731016303520/v2_201705020105/en/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S1578219017300604" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.03.010" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1541" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:383-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 677 "formatos" => array:3 [ "EPUB" => 59 "HTML" => 461 "PDF" => 157 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Efficacy and Safety of Omalizumab in a Patient With Chronic Spontaneous Urticaria and Active Hepatitis B Virus Infection" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "383" "paginaFinal" => "384" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficacia y seguridad de omalizumab en un paciente con urticaria crónica espontánea e infección activa por el virus de la hepatitis B" ] ] "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" => 841 "Ancho" => 1664 "Tamanyo" => 64111 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Changes in Urticaria Activity Score 7 (UAS7) scores and hepatitis B viral loads measured by polymerase chain reaction (PCR HBV) during treatment with omazlizumab.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Chicharro, P. Rodríguez-Jiménez, D. de Argila" "autores" => array:3 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Chicharro" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Rodríguez-Jiménez" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "de Argila" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101630357X" "doi" => "10.1016/j.ad.2016.10.005" "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/S000173101630357X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017300604?idApp=UINPBA000044" "url" => "/15782190/0000010800000004/v1_201704280927/S1578219017300604/v1_201704280927/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Giant periurethral condyloma acuminata in a 2-year-old girl: Successful treatment with carbon dioxide laser" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "385" "paginaFinal" => "387" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "X. Calderón-Castrat, S. Blanco, J.C. Santos-Durán, M. Roncero-Riesco" "autores" => array:4 [ 0 => array:4 [ "nombre" => "X." "apellidos" => "Calderón-Castrat" "email" => array:1 [ 0 => "xime_777@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Blanco" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Santos-Durán" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Roncero-Riesco" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, University Hospital of Salamanca, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Condiloma acuminado periuretral gigante en niña de 2 años: tratamiento exitoso con láser de dióxido de carbono" ] ] "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" => 1724 "Ancho" => 2500 "Tamanyo" => 617798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Giant periurethral condyloma acuminata. (B) 13-month follow-up post-CO<span class="elsevierStyleInf">2</span> laser surgery for the giant periurethral condyloma acuminata.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pediatric anogenital condyloma acuminata (CA) is not infrequent, as increasing reports of its prevalence have demonstrated in recent years.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> However, periurethral CA is an unusual location for this virally transmitted disease and is exceptionally reported in medical literature. Human papilloma viruses (HPV) are the etiological causes for all types of warts, and variable modes of transmission both sexual and non-sexual, have been described in the pediatric population.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Current treatments for anogenital CA in children prove challenging due to their young age, anatomic location and the high recurrence rates.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3</span></a> Multiple therapeutic approaches range from topical treatments to more aggressive procedures, including surgery.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present an otherwise healthy, 2-year-old girl referred to our Department of Dermatology, with progressively increasing asymptomatic lesions in the diaper area of 2 months in duration. Physical examination showed multiple flesh-colored and brownish papules of 1–2<span class="elsevierStyleHsp" style=""></span>mm in diameter located in the vestibular and vulvar region in a symmetric V-shaped distribution as well as in the perianal region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>(A)) Additionally, careful periurethral examination revealed an exophytic, reddish and papillomatous lesion of 1.2<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>(A)) observing rich vascularity with dermoscopy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A clinical diagnosis of CA stage IV was established due to the extension of the lesions.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> PCR testing was performed for the vulvar, perianal and the periurethral lesions confirming the diagnosis of CA for HPV subtype 6. Subsequently, the patient was screened for other sexually transmitted diseases and reported to social services for possible child abuse investigations. The father presented genital warts, however, PCR testing results were not conclusive for the detection and typification of the HPV. No further information was retrieved from the mother. The exact source of infection could not be determined, but most importantly, no signs of sexual abuse were identified.</p><p id="par0020" class="elsevierStylePara elsevierViewall">CO<span class="elsevierStyleInf">2</span> laser surgery was proposed as a prompt solution for lack of sphincter control and the giant periurethral CA. The procedure was carried out in an in-patient regimen under general anesthesia and prophylactic systemic antibiotic with cefazolin. Under gynecological examination, urethral catheterization was performed. The operators were required to use a mask to prevent HPV in the vapor plume emitted by the CO<span class="elsevierStyleInf">2</span> laser. Vaporization with CO<span class="elsevierStyleInf">2</span> laser was performed with the following parameters: 5 Watts, continuous mode and repeated pulse in two consecutive passes. After vaporization and using the same CO<span class="elsevierStyleInf">2</span> laser parameters, the periurethral wart was coagulated from the base and sent for histopathological analysis. The treated area was covered with mupirocin ointment and a non-adherent dressing, both of which were changed on a daily basis until complete healing was achieved. The laser surgery lasted approximately 30<span class="elsevierStyleHsp" style=""></span>min with no intra or postoperative complications. The histopathological study revealed acanthosis and parakeratosis with elongation of rete ridges and the presence of koilocytes, features consistent with CA. Complete epithelialization was achieved within 9 days and only one session was required to achieve clearance. The giant periurethral and anogenital CA did not recur. A 13-month follow-up shows complete remission and no signs of scarring (<a class="elsevierStyleCrossRefs" href="#fig0005">Fig. 1(B) and 2(B)</a>).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Anogenital CA in the pediatric population is not rare in daily practice as one may suppose.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> However, giant periurethral condyloma occurs exceptionally in association with extensive dissemination of CA.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> Most importantly, anogenital HPV infection in this particular age group poses a therapeutic challenge. Among several treatment recommendations for CA are podophyllin or imiquimod,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> trichloroacetic acid, 5-fluorouracil,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> cryotherapy, CO<span class="elsevierStyleInf">2</span> laser,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> electrocautery and surgery,<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5-7</span></a> all of which present variable cure and recurrence rates. The multiple approaches and varying responses suggest that there is no gold standard for the treatment of CA in children<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6-8</span></a> and while topical treatments are indicated as a first line approach, there is no consensus regarding pediatric management.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7-9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In our case, topical therapy was not a treatment option owing to the clinical presentation of the periurethral CA. Another important factor taken into account, was the infant that required diapers, for the occlusion and constant diaper changes would have interfered with the topical treatments, leading to possible lack of therapeutic effectiveness and adherence. However, the greatest concern was the periurethral wart, which due to size and location required a surgical procedure.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">CO<span class="elsevierStyleInf">2</span> laser surgery is an effective technique, demonstrating rapid healing and lower recurrence rates as the main advantages.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4</span></a> In our patient's case, after 9 days and only one session, complete epithelialization was achieved and no recurrence was observed in the 13-month follow-up (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>(B)). To our knowledge, this is the first pediatric case presenting a periurethral CA successfully treated with CO<span class="elsevierStyleInf">2</span> laser reported in medical literature.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In summary, we report the outstanding results achieved with the CO<span class="elsevierStyleInf">2</span> laser for the treatment of a periurethral and disseminated CA in a pediatric patient. We therefore recommend this surgical procedure in cases where large CA in association with extensive disseminated infection are observed.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "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" => 1304 "Ancho" => 2500 "Tamanyo" => 462629 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Multiple vestibular and vulvar condyloma acuminata. (B) 13-month follow-up post-CO<span class="elsevierStyleInf">2</span> laser surgery of anogenital condyloma acuminata.</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" => 1724 "Ancho" => 2500 "Tamanyo" => 617798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Giant periurethral condyloma acuminata. (B) 13-month follow-up post-CO<span class="elsevierStyleInf">2</span> laser surgery for the giant periurethral condyloma acuminata.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric anogenital warts: a 7-year review of children referred to a tertiary-care hospital in Montreal, Canada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Marcoux" 1 => "K. Nadeau" 2 => "C. McCuaig" 3 => "J. Powell" 4 => "L.L. Oligny" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-1470.2006.00218.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2006" "volumen" => "23" "paginaInicial" => "199" "paginaFinal" => "207" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16780463" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant condyloma acuminate due to human papillomavirus type 16 in an infant successfully treated with topical imiquimod therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Dinleyici" 1 => "N. Saracoglu" 2 => "M. Eren" 3 => "Ö. Kiliç" 4 => "E. Ciftci" 5 => "E.C. Dinleyici" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4081/dr.2015.6134" "Revista" => array:5 [ "tituloSerie" => "Dermatol Reports" "fecha" => "2015" "volumen" => "7" "paginaInicial" => "6134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26734121" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carbon dioxide Laser ablation of anogenital condyloma acuminata in pediatric patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.J. Johnson" 1 => "T.H. Mirzai" 2 => "M.L. Bentz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Plast Surg" "fecha" => "1997" "volumen" => "39" "paginaInicial" => "578" "paginaFinal" => "582" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9418915" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periurethral and vulval condylomata acuminata: an unusual juvenile venereal disease in a 3-year-old girl" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.V. Patel" 1 => "D. Desai" 2 => "A. Cherian" 3 => "C. Martyn-Simmons" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2014" "paginaInicial" => "2014" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perianal giant condyloma acuminata in an infant: an alarming lesion for a pediatric surgeon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Altinay-Kirli" 1 => "S. Güçer" 2 => "I. Karnak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Turk J Pediatr" "fecha" => "2011" "volumen" => "53" "paginaInicial" => "333" "paginaFinal" => "336" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21980819" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Children with Warts: a retrospective study in an outpatient setting" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.M. Kuwabara" 1 => "B.M. Rainer" 2 => "H. Basdag" 3 => "B.A. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pde.12584" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2015" "volumen" => "32" "paginaInicial" => "679" "paginaFinal" => "683" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25879618" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update: treatment of cutaneous viral warts in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Boull" 1 => "D. Groth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-1470.2010.01378.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2011" "volumen" => "28" "paginaInicial" => "217" "paginaFinal" => "229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21517951" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence based treatment and prevention of external genital warts in female pediatric and adolescent patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Thornsberry" 1 => "J.C. English 3rd" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Adolesc Gynecol" "fecha" => "2012" "volumen" => "25" "paginaInicial" => "150" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22530225" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant condyloma acuminatum in an infant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Tinsa" 1 => "A. Gharbi" 2 => "A. Essid" 3 => "M. Driss" 4 => "S. Bousnina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-1470.2009.00968.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2009" "volumen" => "26" "paginaInicial" => "488" "paginaFinal" => "489" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19689540" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000004/v1_201704280927/S1578219017301178/v1_201704280927/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/15782190/0000010800000004/v1_201704280927/S1578219017301178/v1_201704280927/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017301178?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 6 | 19 |
| 2024 October | 72 | 55 | 127 |
| 2024 September | 78 | 30 | 108 |
| 2024 August | 96 | 74 | 170 |
| 2024 July | 79 | 38 | 117 |
| 2024 June | 86 | 22 | 108 |
| 2024 May | 59 | 34 | 93 |
| 2024 April | 63 | 30 | 93 |
| 2024 March | 66 | 27 | 93 |
| 2024 February | 61 | 35 | 96 |
| 2024 January | 44 | 27 | 71 |
| 2023 December | 46 | 17 | 63 |
| 2023 November | 53 | 23 | 76 |
| 2023 October | 50 | 20 | 70 |
| 2023 September | 49 | 32 | 81 |
| 2023 August | 37 | 18 | 55 |
| 2023 July | 43 | 33 | 76 |
| 2023 June | 45 | 26 | 71 |
| 2023 May | 43 | 24 | 67 |
| 2023 April | 31 | 21 | 52 |
| 2023 March | 34 | 22 | 56 |
| 2023 February | 40 | 22 | 62 |
| 2023 January | 48 | 25 | 73 |
| 2022 December | 49 | 40 | 89 |
| 2022 November | 22 | 32 | 54 |
| 2022 October | 25 | 19 | 44 |
| 2022 September | 19 | 37 | 56 |
| 2022 August | 21 | 32 | 53 |
| 2022 July | 16 | 47 | 63 |
| 2022 June | 24 | 25 | 49 |
| 2022 May | 39 | 43 | 82 |
| 2022 April | 63 | 58 | 121 |
| 2022 March | 86 | 67 | 153 |
| 2022 February | 72 | 38 | 110 |
| 2022 January | 86 | 39 | 125 |
| 2021 December | 61 | 46 | 107 |
| 2021 November | 54 | 48 | 102 |
| 2021 October | 49 | 44 | 93 |
| 2021 September | 58 | 30 | 88 |
| 2021 August | 109 | 36 | 145 |
| 2021 July | 121 | 26 | 147 |
| 2021 June | 42 | 25 | 67 |
| 2021 May | 72 | 41 | 113 |
| 2021 April | 371 | 45 | 416 |
| 2021 March | 159 | 36 | 195 |
| 2021 February | 111 | 35 | 146 |
| 2021 January | 97 | 24 | 121 |
| 2020 December | 87 | 26 | 113 |
| 2020 November | 123 | 28 | 151 |
| 2020 October | 105 | 19 | 124 |
| 2020 September | 262 | 19 | 281 |
| 2020 August | 267 | 15 | 282 |
| 2020 July | 283 | 20 | 303 |
| 2020 June | 282 | 39 | 321 |
| 2020 May | 132 | 9 | 141 |
| 2020 April | 21 | 16 | 37 |
| 2020 March | 15 | 10 | 25 |
| 2020 February | 3 | 0 | 3 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 6 | 0 | 6 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 7 | 0 | 7 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 6 | 0 | 6 |
| 2019 April | 2 | 2 | 4 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 6 | 0 | 6 |
| 2018 September | 6 | 0 | 6 |
| 2018 February | 9 | 3 | 12 |
| 2018 January | 21 | 7 | 28 |
| 2017 December | 14 | 5 | 19 |
| 2017 November | 16 | 5 | 21 |
| 2017 October | 22 | 6 | 28 |
| 2017 September | 14 | 9 | 23 |
| 2017 August | 27 | 7 | 34 |
| 2017 July | 12 | 7 | 19 |
| 2017 June | 34 | 10 | 44 |
| 2017 May | 38 | 23 | 61 |
| 2017 April | 4 | 3 | 7 |
Show all
