Case for Diagnosis
Beaded Nodules on the Forearms
Nódulos «arrosariados» en antebrazos
I. García Río
, S. Heras Gonzalez, M.I. Martínez Gonzalez
Corresponding author
Servicio de Dermatología, Hospital Universitario de Araba, Vitoria-Gasteiz, Álava, Spain
Read
5102
Timeswas read the article
1489
Total PDF
3613
Total HTML
Share statistics
array:24 [ "pii" => "S1578219019300587" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.02.019" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "2037" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:597-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 11 "formatos" => array:2 [ "HTML" => 10 "PDF" => 1 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731018303569" "issn" => "00017310" "doi" => "10.1016/j.ad.2017.08.023" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "2037" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:597-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 342 "formatos" => array:2 [ "HTML" => 275 "PDF" => 67 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Casos para el diagnóstico</span>" "titulo" => "Nódulos «arrosariados» en antebrazos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "597" "paginaFinal" => "598" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Beaded Nodules on the 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" => 277 "Ancho" => 500 "Tamanyo" => 17961 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. García Río, S. Heras Gonzalez, M.I. Martínez Gonzalez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "García Río" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Heras Gonzalez" ] 2 => array:2 [ "nombre" => "M.I." "apellidos" => "Martínez Gonzalez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219019300587" "doi" => "10.1016/j.adengl.2019.02.019" "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/S1578219019300587?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018303569?idApp=UINPBA000044" "url" => "/00017310/0000011000000007/v1_201909021023/S0001731018303569/v1_201909021023/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219019301271" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.04.013" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "2126" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:599-600" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Indurated Papules on the Face" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "599" "paginaFinal" => "600" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápulas faciales induradas" ] ] "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" => 612 "Ancho" => 850 "Tamanyo" => 95209 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. González-Cruz, V. Cabezas, V. García-Patos" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "González-Cruz" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Cabezas" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "García-Patos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018305520" "doi" => "10.1016/j.ad.2018.01.018" "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/S0001731018305520?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019301271?idApp=UINPBA000044" "url" => "/15782190/0000011000000007/v1_201909021030/S1578219019301271/v1_201909021030/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219018302701" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.07.017" "estado" => "S300" "fechaPublicacion" => "2019-09-01" "aid" => "1979" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:590-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">BRIEF COMUNICATIONS</span>" "titulo" => "Clinical, Dermoscopic and Histologic Features of Recurrent Cutaneous Eosinophilic Vasculitis Cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "590" "paginaFinal" => "596" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características clínicas, dermatoscópicas e histológicas de varios casos de vasculitis eosinofílica recurrente cutánea" ] ] "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" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1623 "Ancho" => 911 "Tamanyo" => 130110 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(a) Case 1 histology: diffuse infiltration of eosinophils dispersed and invading necrotized superficial blood vessels. (b) Case 2 histology: fibrinoid necrosis of superficial blood vessels surrounded by eosinophils.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E.G. Quijano-Gomero, M.J.M. Rodríguez-Zúñiga, M.E. Sanz-Montero, D. Durand-Buse" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E.G." "apellidos" => "Quijano-Gomero" ] 1 => array:2 [ "nombre" => "M.J.M." "apellidos" => "Rodríguez-Zúñiga" ] 2 => array:2 [ "nombre" => "M.E." "apellidos" => "Sanz-Montero" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Durand-Buse" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018302370" "doi" => "10.1016/j.ad.2017.12.012" "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/S0001731018302370?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302701?idApp=UINPBA000044" "url" => "/15782190/0000011000000007/v1_201909021030/S1578219018302701/v1_201909021030/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Beaded Nodules on the Forearms" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "597" "paginaFinal" => "598" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. García Río, S. Heras Gonzalez, M.I. Martínez Gonzalez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "García Río" "email" => array:1 [ 0 => "Irene@aedv.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Heras Gonzalez" ] 2 => array:2 [ "nombre" => "M.I." "apellidos" => "Martínez Gonzalez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Araba, Vitoria-Gasteiz, Álava, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulos «arrosariados» en antebrazos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 401 "Ancho" => 207 "Tamanyo" => 8963 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">An 83-year-old woman with a history of hypothyroidism and depression, which was being treated, was referred to our department by the rheumatology department, where she was in follow-up for osteoporosis. She reported the gradual appearance of asymptomatic nodules on the forearms; the nodules had appeared a year earlier and were not associated with prior trauma or any other trigger.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient presented between 8 and 10 subcutaneous nodules in the cubital region of both forearms; the nodules measured between 0.5 and 1.5<span class="elsevierStyleHsp" style=""></span>cm in diameter, were of a rubbery consistency, skin-colored, with a smooth surface, rounded, and arrayed in a line (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient presented joint deformities of the metacarpophalangeal joints with no signs of arthritis, and no other skin lesions were observed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Involvement of the entire thickness of the dermis was observed, with foci of partial collagen degeneration, surrounded by a discrete lymphohistiocytic infiltrate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Tests revealed elevated PCR (30.7<span class="elsevierStyleHsp" style=""></span>mg/L); ANA (+) at a 1/320 titer, and anti-ENA (+); SS-A, 68<span class="elsevierStyleHsp" style=""></span>U/mL. Other parameters (hemogram, biochemistry, erythrocyte sedimentation rate, rheumatoid factor, anti-CCP2, urinary sediment, proteinogram, immunoglobulins, C3, C4, anticardiolipin antibodies) were normal or negative. X-ray of the hands, forearms, and spine showed signs of degeneration and reduced bone density.</p></span><span id="sec1025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1025">What Is Your Diagnosis?</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Subcutaneous granuloma annulare.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Because of the pain reported by the patient, after a 1-year follow-up period, treatment with 2 intralesional injections of triamcinolone in suspension at a concentration of 1:2 was instated, followed by oral vitamin E (200<span class="elsevierStyleHsp" style=""></span>mg/d) for 6 months. The condition resolved completely and no relapse was observed in the last 10 months of follow-up (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Granuloma annulare (GA) is a benign form of dermatosis of uncertain origin and is generally self-limiting; it may present different clinical forms, the most common of which are localized, generalized, subcutaneous, and perforating GA.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Several rare or atypical patterns of GA exist, including follicular GA, macular GA, patch GA, and linear GA.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> Subcutaneous granuloma annulare (SGA) is a rare variant of GA and is more frequent in children. It is characterized by the appearance of asymptomatic unadhered nodules of variable size and a firm elastic consistency, with normal overlying skin.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> The most frequent locations are the head, lower extremities, forearms, and backs of the hands and feet.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> Diagnosis is clinical and histologic, and the disease presents a broad differential diagnosis that includes abscesses, calcified hematomas, soft-tissue tumors, fat necrosis, reaction to foreign bodies, and interstitial granulomatous dermatitis. Histopathologic differentiation, however, should principally include rheumatoid nodules (RN).<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> Differentiation may be difficult, as both diseases present a granulomatous dermal infiltrate consisting of an area of collagen necrobiosis surrounded by palisading histiocytes.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> RN present better circumscribed abnormal connective tissue located more deeply and fibrin deposition in the collagen is highly characteristic.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> RN tend to have giant cells in the palisade of histiocytes, but the key histiologic finding for differentiating the diseases is the presence of mucin in the area of necrobiosis in SGA.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> In our patient, we identified mucin deposits using colloidal iron and Alcian blue, which together with negative results for RF and anti-CCP2 and the absence of clinical findings of rheumatologic disease, aided us to perform the differential diagnosis between the 2 processes. With respect to treatment, many drugs have been proposed with variable results; the most accepted approach is not to treat.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> In our case, we decided to treat, with an excellent response; nevertheless, the possibility that remission was spontaneous cannot be ruled out. Few cases of SGA or linear GA have been reported and we have found no cases similar to ours. We would like to highlight the exceptional nature of the clinical presentation, in the form of linear beaded nodules, which has not been described to date. While this is an atypical presentation, the potential diagnosis of SGA should be taken into account to avoid unnecessary treatment.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0040" 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" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:3 [ "identificador" => "sec1025" "titulo" => "What Is Your Diagnosis?" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] ] ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0040" "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: García Río I, Heras Gonzalez S, Martínez Gonzalez MI. Beaded Nodules on the Forearms. Actas Dermosifiliogr. 2019;110:597–598.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 277 "Ancho" => 501 "Tamanyo" => 17993 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 667 "Ancho" => 905 "Tamanyo" => 142631 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin–eosin ×1.3. B, Hematoxylin–eosin ×2.6.</p>" ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 401 "Ancho" => 207 "Tamanyo" => 8963 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma annulare: Clinical and histologic variants, epidemiology and genetics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.W. Piette" 1 => "M. Rosenbach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2015.03.054" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2016" "volumen" => "75" "paginaInicial" => "457" "paginaFinal" => "465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27543209" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma anular lineal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. López-Obregón" 1 => "A. Mª López-Núñez" 2 => "A. López-Pestaña" 3 => "C. Tuneu" 4 => "P. Lobo" 5 => "Eguino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Cutan Iber Lat Am" "fecha" => "2010" "volumen" => "38" "paginaInicial" => "244" "paginaFinal" => "247" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asymptomatic papulo-nodules localized to one finger" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.D. Rambhia" 1 => "U.S. Khopkar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5154.164441" "Revista" => array:7 [ "tituloSerie" => "Indian J Dermatol" "fecha" => "2015" "volumen" => "60" "paginaInicial" => "522" "paginaFinal" => "525" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26538733" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022395610002165" "estado" => "S300" "issn" => "00223956" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subcutaneous granuloma annulare" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Requena" 1 => "M.T. Fernández-Figueras" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.sder.2007.02.006" "Revista" => array:6 [ "tituloSerie" => "Semin Cutan Med Surg" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "96" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17544961" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Nodulosis reumatoidea o granuloma anular profundo?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Revenga Arranz" 1 => "P. Sanz Moncasi" 2 => "J. Paricio Rubio" 3 => "J. Medina Luezas" 4 => "P. Ruiz Martinez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "1999" "volumen" => "90" "paginaInicial" => "124" "paginaFinal" => "127" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000007/v1_201909021030/S1578219019300587/v1_201909021030/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/15782190/0000011000000007/v1_201909021030/S1578219019300587/v1_201909021030/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019300587?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 8 | 18 |
| 2024 October | 82 | 42 | 124 |
| 2024 September | 86 | 29 | 115 |
| 2024 August | 116 | 48 | 164 |
| 2024 July | 115 | 39 | 154 |
| 2024 June | 78 | 28 | 106 |
| 2024 May | 102 | 39 | 141 |
| 2024 April | 78 | 17 | 95 |
| 2024 March | 86 | 24 | 110 |
| 2024 February | 76 | 45 | 121 |
| 2024 January | 105 | 33 | 138 |
| 2023 December | 81 | 17 | 98 |
| 2023 November | 89 | 32 | 121 |
| 2023 October | 71 | 23 | 94 |
| 2023 September | 69 | 31 | 100 |
| 2023 August | 49 | 14 | 63 |
| 2023 July | 74 | 29 | 103 |
| 2023 June | 61 | 26 | 87 |
| 2023 May | 81 | 21 | 102 |
| 2023 April | 101 | 14 | 115 |
| 2023 March | 122 | 22 | 144 |
| 2023 February | 74 | 19 | 93 |
| 2023 January | 32 | 20 | 52 |
| 2022 December | 60 | 37 | 97 |
| 2022 November | 44 | 25 | 69 |
| 2022 October | 39 | 17 | 56 |
| 2022 September | 58 | 36 | 94 |
| 2022 August | 74 | 33 | 107 |
| 2022 July | 68 | 36 | 104 |
| 2022 June | 31 | 32 | 63 |
| 2022 May | 77 | 36 | 113 |
| 2022 April | 82 | 26 | 108 |
| 2022 March | 85 | 57 | 142 |
| 2022 February | 77 | 24 | 101 |
| 2022 January | 105 | 33 | 138 |
| 2021 December | 84 | 37 | 121 |
| 2021 November | 69 | 42 | 111 |
| 2021 October | 66 | 45 | 111 |
| 2021 September | 56 | 31 | 87 |
| 2021 August | 58 | 31 | 89 |
| 2021 July | 48 | 20 | 68 |
| 2021 June | 41 | 18 | 59 |
| 2021 May | 50 | 33 | 83 |
| 2021 April | 99 | 45 | 144 |
| 2021 March | 70 | 20 | 90 |
| 2021 February | 52 | 19 | 71 |
| 2021 January | 36 | 10 | 46 |
| 2020 December | 33 | 8 | 41 |
| 2020 November | 23 | 19 | 42 |
| 2020 October | 21 | 8 | 29 |
| 2020 September | 34 | 13 | 47 |
| 2020 August | 24 | 17 | 41 |
| 2020 July | 13 | 11 | 24 |
| 2020 June | 21 | 18 | 39 |
| 2020 May | 19 | 9 | 28 |
| 2020 April | 21 | 11 | 32 |
| 2020 March | 23 | 9 | 32 |
| 2020 February | 4 | 2 | 6 |
| 2019 May | 0 | 1 | 1 |
| 2019 March | 10 | 0 | 10 |
Show all
