Case for Diagnosis
Bilateral Annular Plaques on the Hands and Forearms
Placas anulares bilaterales en manos y antebrazos
E. Rozas-Muñoz
, J.F. Mir-Bonafé, E. Serra-Baldrich
Corresponding author
Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Read
5091
Timeswas read the article
2093
Total PDF
2998
Total HTML
Share statistics
array:24 [ "pii" => "S1578219018300088" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.02.006" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "1714" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:263-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 57 "HTML" => 57 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731017303058" "issn" => "00017310" "doi" => "10.1016/j.ad.2017.04.022" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "1714" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:263-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 340 "formatos" => array:2 [ "HTML" => 236 "PDF" => 104 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Casos para el diagnóstico</span>" "titulo" => "Placas anulares bilaterales en manos y antebrazos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "263" "paginaFinal" => "264" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Bilateral Annular Plaques on the Hands and Forearms" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1081 "Ancho" => 1658 "Tamanyo" => 271539 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Rozas-Muñoz, J.F. Mir-Bonafé, E. Serra-Baldrich" "autores" => array:3 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Rozas-Muñoz" ] 1 => array:2 [ "nombre" => "J.F." "apellidos" => "Mir-Bonafé" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Serra-Baldrich" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219018300088" "doi" => "10.1016/j.adengl.2018.02.006" "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/S1578219018300088?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017303058?idApp=UINPBA000044" "url" => "/00017310/0000010900000003/v1_201804020403/S0001731017303058/v1_201804020403/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219018300076" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.02.005" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "1710" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:265-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 60 "HTML" => 60 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Fast-growing Tumor of the Eyelid" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "265" "paginaFinal" => "266" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumor de rápido crecimiento en el párpado" ] ] "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" => 1283 "Ancho" => 1167 "Tamanyo" => 264708 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C.A. Morales-Cardona, C. Rodríguez-Zakzuk, A. Téllez-Lozada" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C.A." "apellidos" => "Morales-Cardona" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Rodríguez-Zakzuk" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Téllez-Lozada" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017302788" "doi" => "10.1016/j.ad.2016.10.024" "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/S0001731017302788?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018300076?idApp=UINPBA000044" "url" => "/15782190/0000010900000003/v1_201804020430/S1578219018300076/v1_201804020430/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219018300064" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.02.004" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "1688" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:e17-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 61 "formatos" => array:2 [ "HTML" => 59 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">e-Case Report</span>" "titulo" => "Color Doppler Ultrasound Study of Glomuvenous Malformations with its Clinical and Histologic Correlations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e17" "paginaFinal" => "e21" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ecografía Doppler color en malformaciones glomuvenosas con correlación clínica e histológica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1849 "Ancho" => 3333 "Tamanyo" => 680519 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A-B, Color Doppler spectral analysis showing single-phase venous vascularization in affected areas. C-F, Color Doppler spectral analysis showing two-phase (systolic and diastolic) arterial vascularization in affected areas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "X. Wortsman, F. Millard, L. Aranibar" "autores" => array:3 [ 0 => array:2 [ "nombre" => "X." "apellidos" => "Wortsman" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Millard" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Aranibar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017302417" "doi" => "10.1016/j.ad.2017.04.013" "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/S0001731017302417?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018300064?idApp=UINPBA000044" "url" => "/15782190/0000010900000003/v1_201804020430/S1578219018300064/v1_201804020430/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Bilateral Annular Plaques on the Hands and Forearms" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "263" "paginaFinal" => "264" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Rozas-Muñoz, J.F. Mir-Bonafé, E. Serra-Baldrich" "autores" => array:3 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Rozas-Muñoz" "email" => array:1 [ 0 => "docrozas@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.F." "apellidos" => "Mir-Bonafé" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Serra-Baldrich" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placas anulares bilaterales en manos y antebrazos" ] ] "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" => 1081 "Ancho" => 1658 "Tamanyo" => 272209 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 56-year-old man with no relevant past history presented with mildly pruritic lesions on the dorsal aspect of both forearms that had first appeared 8 months earlier. The patient reported no history of applying products to the affected area and mentioned no possible triggers.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed large erythematous plaques with slightly raised borders and a central depression affecting the dorsal aspect of both forearms and hands. The lesions had an annular morphology and, interestingly, spared the area covered by the watch on the left wrist (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Epicutaneous tests from the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) and standard photopatch tests were negative.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0020" class="elsevierStylePara elsevierViewall">Histologic examination of a punch biopsy specimen taken from the border of one of the plaques revealed an epidermis without significant alterations. A superficial granulomatous and perivascular infiltrate composed of mononuclear cells and multinucleated giant cells was observed in the upper and mid dermis. The cytoplasm of these cells contained numerous fragmented elastic fibers rendered more visible by Verhoeff-Van Gieson staining. Neither collagen degeneration nor the presence of mucin were observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Annular elastolytic giant cell granuloma (actinic granuloma).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment was started with medium-strength topical corticosteroids and sun protection. Partial improvement of the lesions was observed after 3 months of application.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Annular elastolytic giant cell granuloma (AEGCG), also known as actinic granuloma or O’Brien granuloma, is a rare granulomatous disease characterized by the presence of multinucleated giant cells with phagocytosis of anomalous elastic fibers, a process known as elastophagocytosis. AEGCG mainly affects women aged 50 to 70 years with a light skin phototype and signs of chronic actinic damage. The lesions usually begin as erythematous papules that later evolve into annular plaques with raised borders and a minimal atrophic center. The most common sites are sun-exposed areas such as the face, upper chest, and legs.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The pathogenesis of this entity is unknown, although the possibility of an autoimmune reaction directed against elastic fibers, determining a granulomatous inflammatory response with the formation of granulomas, has been postulated.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> AEGCG has been described in association with various processes, including diabetes mellitus, medication use, hypothyroidism, thyroiditis, lymphomas, polymyalgia rheumatica, and temporal arteritis.</p><p id="par0050" class="elsevierStylePara elsevierViewall">At present, it is not known whether there is a relationship between AEGCG and these processes.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Histopathology shows 3 well-defined zones that reflect this possible pathogenesis. A peripheral zone, outside the borders of the plaques, is characterized by a papillary dermis with actinic elastosis, without the presence of multinucleated giant cells or granulomas. This zone, in which the lesion progresses, contains antigenic elastic fibers that have not yet induced an inflammatory reaction. In an intermediate or active zone—corresponding clinically to the edge of the lesions—fragmented elastic fibers, elastophagocytosis phenomena, and granuloma formation are observed. Finally, a central zone, characterized by the absence of elastic fibers and few inflammatory cells, is the residual postinflammatory zone.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The main differential diagnosis is granuloma annulare (GA) at sun-exposed sites. In fact, since AEGCG was first described, there has been some debate about whether it is a distinct entity or a variant of GA with elastophagocytosis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Although these two processes can be clinically identical, histologic studies support the idea that they are separate entities. In AEGCG, the granulomatous reaction is found mainly in the upper dermis and no mucin is observed, whereas in GA, granulomas are distributed throughout the upper and mid dermis, forming a palisade around an area characterized by degenerated collagen and the presence of mucin.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Although spontaneous remission has been reported in some cases, AEGCG tends to be chronic and recurring. Multiple treatment options have been described, including sun protection; topical, systemic, or intralesional corticosteroids; chloroquine; dapsone; methotrexate; anti–tumor necrosis factor (TNF) monoclonal antibodies; and low-dose oral retinoids. These treatments have produced variable results.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6–8</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rozas-Muñoz E, Mir-Bonafé JF, Serra-Baldrich E. Placas anulares bilaterales en manos y antebrazos. Actas Dermosifiliogr. 2018;109:263–264.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1081 "Ancho" => 1658 "Tamanyo" => 272209 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1570 "Ancho" => 1625 "Tamanyo" => 1024193 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>4. B, Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>40. C, Verhoeff-Van Gieson, original magnification ×<span class="elsevierStyleHsp" style=""></span>40. D, Alcian blue, original magnification ×<span class="elsevierStyleHsp" style=""></span>20.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma actínico. Estudio clínico e histológico de cinco casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Bassas-Vila" 1 => "P. Umbert" 2 => "M. Iglesias" 3 => "L. Creus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2004" "volumen" => "95" "paginaInicial" => "451" "paginaFinal" => "455" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actinically degenerated elastic tissue is the likely antigenic basis of actinic granuloma of the skin and of temporal arteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.P. O’Brien" 1 => "W. Regan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1999" "volumen" => "40" "paginaInicial" => "214" "paginaFinal" => "222" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10025748" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actinic granuloma. The expanding significance. An analysis of its origin in elastotic (aging) skin and a definition of necrobiotic (vascular), histiocytic, and sarcoid variants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.P. O’Brien" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Int J Dermatol" "fecha" => "1985" "volumen" => "24" "paginaInicial" => "473" "paginaFinal" => "490" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2415473" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0007091217310711" "estado" => "S300" "issn" => "00070912" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is actinic granuloma a specific condition?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Ragaz" 1 => "B.A. Ackerman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "1979" "volumen" => "1" "paginaInicial" => "43" "paginaFinal" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/398673" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actinic granuloma is a unique and distinct entity: A comparative study with granuloma annulare" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.A. Al-Hoqail" 1 => "A.M. Al-Ghamdi" 2 => "M. Martinka" 3 => "R.I. Crawford" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2002" "volumen" => "24" "paginaInicial" => "209" "paginaFinal" => "212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12140436" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0952818016307139" "estado" => "S300" "issn" => "09528180" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "O’Brien's actinic granuloma: An unusually extensive presentation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Lazzarini" 1 => "A. Rotter" 2 => "D.C. Farias" 3 => "H. Muller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2011" "volumen" => "86" "paginaInicial" => "339" "paginaFinal" => "342" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21603819" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0952818016308789" "estado" => "S300" "issn" => "09528180" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Annular elastolytic giant cell granuloma: A case report located in non-sun exposed areas]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Campos-Muñoz" 1 => "R.M. Díaz-Díaz" 2 => "A. Quesada-Cortés" 3 => "N. Hernández- Cano" 4 => "M.A. Martín-Díaz" 5 => "R.M. Regojo-Zapata" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2006" "volumen" => "97" "paginaInicial" => "533" "paginaFinal" => "535" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17067534" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S095281801600115X" "estado" => "S300" "issn" => "09528180" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Greb JE, Goldminz AM, Rosmarin D. Adalimumab for the treatmentof actinic granuloma. Dermatol Ther. 2017;30:1-2." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000003/v1_201804020430/S1578219018300088/v1_201804020430/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000003/v1_201804020430/S1578219018300088/v1_201804020430/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018300088?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 7 | 14 |
| 2024 October | 77 | 50 | 127 |
| 2024 September | 67 | 26 | 93 |
| 2024 August | 106 | 51 | 157 |
| 2024 July | 90 | 44 | 134 |
| 2024 June | 80 | 33 | 113 |
| 2024 May | 63 | 27 | 90 |
| 2024 April | 87 | 34 | 121 |
| 2024 March | 75 | 25 | 100 |
| 2024 February | 64 | 33 | 97 |
| 2024 January | 54 | 30 | 84 |
| 2023 December | 66 | 27 | 93 |
| 2023 November | 98 | 21 | 119 |
| 2023 October | 61 | 20 | 81 |
| 2023 September | 71 | 34 | 105 |
| 2023 August | 55 | 12 | 67 |
| 2023 July | 40 | 33 | 73 |
| 2023 June | 50 | 27 | 77 |
| 2023 May | 69 | 20 | 89 |
| 2023 April | 58 | 19 | 77 |
| 2023 March | 68 | 28 | 96 |
| 2023 February | 70 | 32 | 102 |
| 2023 January | 38 | 30 | 68 |
| 2022 December | 72 | 36 | 108 |
| 2022 November | 25 | 33 | 58 |
| 2022 October | 32 | 21 | 53 |
| 2022 September | 26 | 40 | 66 |
| 2022 August | 30 | 30 | 60 |
| 2022 July | 63 | 34 | 97 |
| 2022 June | 31 | 26 | 57 |
| 2022 May | 40 | 47 | 87 |
| 2022 April | 60 | 44 | 104 |
| 2022 March | 55 | 60 | 115 |
| 2022 February | 35 | 40 | 75 |
| 2022 January | 41 | 57 | 98 |
| 2021 December | 37 | 52 | 89 |
| 2021 November | 65 | 55 | 120 |
| 2021 October | 52 | 68 | 120 |
| 2021 September | 38 | 45 | 83 |
| 2021 August | 51 | 48 | 99 |
| 2021 July | 42 | 38 | 80 |
| 2021 June | 39 | 44 | 83 |
| 2021 May | 41 | 68 | 109 |
| 2021 April | 85 | 137 | 222 |
| 2021 March | 65 | 49 | 114 |
| 2021 February | 86 | 50 | 136 |
| 2021 January | 48 | 50 | 98 |
| 2020 December | 38 | 41 | 79 |
| 2020 November | 40 | 55 | 95 |
| 2020 October | 16 | 20 | 36 |
| 2020 September | 23 | 16 | 39 |
| 2020 August | 38 | 30 | 68 |
| 2020 July | 26 | 20 | 46 |
| 2020 June | 34 | 37 | 71 |
| 2020 May | 18 | 14 | 32 |
| 2020 April | 19 | 14 | 33 |
| 2020 March | 15 | 10 | 25 |
| 2020 February | 3 | 1 | 4 |
| 2020 January | 2 | 0 | 2 |
| 2019 December | 8 | 0 | 8 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 10 | 0 | 10 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 6 | 0 | 6 |
| 2019 April | 2 | 0 | 2 |
| 2019 March | 2 | 0 | 2 |
| 2019 February | 2 | 0 | 2 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 1 | 0 | 1 |
| 2018 September | 3 | 0 | 3 |
| 2018 April | 1 | 0 | 1 |
Show all
