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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dupilumab is a biologic drug that blocks the receptor of interleukins IL-4 and IL-13&#44; and which has shown its efficacy in the treatment of severe atopic dermatitis &#40;AD&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> Although the results of dupilumab in real clinical practice are limited&#44; our own experience has shown a behavior similar to that obtained in prior clinical trials&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Other researchers&#44; however&#44; have observed a higher incidence of adverse effects &#40;AEs&#41;&#44; mainly eye disorders and transitory eosinophilia&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Given this disagreement and because the mechanism of action is completely novel&#44; we believe that is is useful to examine in greater depth the safety profile resulting from blocking this immune pathway&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In clinical trials&#44; the most common AEs were infections and infestations&#44; eye disorders&#44; site-of-injection reactions&#44; headache&#44; and skin infection &#40;non-herpes and herpes&#41;&#44; although the incidence was&#44; in general&#44; low&#46; Indeed&#44; the incidence of severe AEs that led to suspension of the drug was less than in the placebo arm&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> which indicates that this mechanism of action has a favorable safety profile&#46; Dupilumab appears to be linked to a reduction in the incidence of skin infections and eczema herpeticum in adults with moderate to severe AD&#46; The underlying mechanism of this link is unclear&#44; but it seems likely that it is associated with the improvement of the AD&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Of the novel AEs observed in treatment with dupilumab&#44; a greater incidence of ocular AEs&#44; principally allergic conjunctivitis&#44; was noted in the treatment groups&#46; Most cases were moderate or severe and were self-limiting&#59; no severe cases were recorded&#46; The trials appear to show a tendency to greater severity of these eye disorders in older patients&#44; with a longer duration of AD&#44; who had a more active underlying disease and&#44; especially&#44; a prior history of eye disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Some authors suggest that the cases of allergic conjunctivitis may in reality be cases of keratoconjunctivitis&#44; often associated with the AD itself&#44; in which blockade of IL-4 and IL-13 signalling may increase the activity of specific ligands involved in the atopic keratoconjunctivitis in the eye&#44; which would suggest a mechanism dependent on the AD and not necessarily related to dupilumab&#46; Furthermore&#44; not all cases have been diagnosed by ophthalmologists&#44; either in clinical trials or in clinical practice&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a> Treatment of the conjunctivitis must include agents that can be administered for long periods of time and that have a favorable safety profile&#46; Fluorometholone eye drops appear to be a safe option in the short term and 0&#46;03&#37; tacrolimus eye drops or ointment are a safe long-term option&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We analyzed a series of 30 patients from 5 hospitals in Andalusia&#44; Spain&#44; included in the extended use of dupilumab in Spain for adult patients with moderate to severe AD&#44; for 52 weeks&#46; The included population presented a significant disease load&#44; with a mean time of 28&#46;5 years since onset of the AD&#46; The most frequent comorbidities in the baseline visit were allergic rhinitis &#40;50&#37;&#41;&#44; conjunctivitis &#40;38&#46;8&#37;&#41;&#44; and extrinsic asthma &#40;22&#46;2&#37;&#41;&#46; All patients had received prior treatment with oral corticosteroids and 94&#46;4&#37; had been treated with cyclosporin&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The safety profile of dupilumab was evaluated at 4&#44; 12&#44; 24&#44; and 52 weeks&#46; The most frequent AE was conjunctivitis&#44; with 5 &#40;16&#37;&#41; reported cases&#46; Other AE were cheilitis&#44; a mild episode of AD&#44; unilateral gynecomastia&#44; and mouth ulcers&#46; All the AEs were transitory and were successfully managed without the need to withdraw the drug&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">With regard to the effectiveness of treatment with dupilumab&#44; in the baseline visit&#44; the mean score was 59&#46;4 on SCORAD scale&#44; 8&#46;3 on the pruritus VAS&#44; and 19 on the DLQI&#46; At week 52 of follow-up&#44; the SCORAD score was 10&#46;5 &#40;a reduction of 82&#46;3&#37; compared to baseline&#41;&#44; the pruritus VAS fell to 2&#46;1 &#40;a reduction of 74&#46;4&#37; compared to baseline&#41;&#44; and the DLQI fell to 2 &#40;a reduction of 89&#46;5&#37; compared to baseline&#41;&#46; The results at the different cutoff points are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The clinical safety and the efficacy of dupilumab in our series were in line with those observed in the clinical trials&#46; Conjunctivitis was considered to be the most frequent AE&#44; but was treated by the dermatologists taking part in this study with ophthalmic corticosteroid eye drops and suspension of treatment was not required&#46; Further&#44; more extensive studies are required&#44; with greater follow-up of the relationship between conjunctivitis and dupilumab to clarify its potential but ambiguous causal relationship&#44; as this adverse event was not observed in studies of dupilumab for other indications&#44; and it may be exclusive to the population with AD and&#44; therefore&#44; linked to the pathophysiology of the disease&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">This study has not received funding of any kind&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline &#40;n&#8239;&#61;&#8239;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 4 &#40;n&#8239;&#61;&#8239;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 12 &#40;n&#8239;&#61;&#8239;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 24 &#40;n&#8239;&#61;&#8239;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 52 &#40;n&#8239;&#61;&#8239;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">SCORAD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Pruritus VAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DLQI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#46;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;77&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
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Case and Research Letters
The safety of dupilumab in clinical practice: 52 weeks of experience at 5 referral hospitals in Andalusia
Análisis de seguridad de dupilumab en práctica clínica real. Experiencia a 52 semanas de cinco centros de referencia en Andalucía
R. Ruiz-Villaverdea,
Corresponding author
ismenios@hotmail.com

Corresponding author.
, J.C. Armario-Hitab, J. Dominguez Cruzc, J.J. Pereyra-Rodriguezc
a Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
b Servicio de Dermatología, Hospital Universitario Puerto Real, Cádiz, Spain
c Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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a greater incidence of ocular AEs&#44; principally allergic conjunctivitis&#44; was noted in the treatment groups&#46; Most cases were moderate or severe and were self-limiting&#59; no severe cases were recorded&#46; The trials appear to show a tendency to greater severity of these eye disorders in older patients&#44; with a longer duration of AD&#44; who had a more active underlying disease and&#44; especially&#44; a prior history of eye disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Some authors suggest that the cases of allergic conjunctivitis may in reality be cases of keratoconjunctivitis&#44; often associated with the AD itself&#44; in which blockade of IL-4 and IL-13 signalling may increase the activity of specific ligands involved in the atopic keratoconjunctivitis in the eye&#44; which would suggest a mechanism dependent on the AD and not necessarily related to dupilumab&#46; Furthermore&#44; not all cases have been diagnosed by ophthalmologists&#44; either in clinical trials or in clinical practice&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a> Treatment of the conjunctivitis must include agents that can be administered for long periods of time and that have a favorable safety profile&#46; Fluorometholone eye drops appear to be a safe option in the short term and 0&#46;03&#37; tacrolimus eye drops or ointment are a safe long-term option&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We analyzed a series of 30 patients from 5 hospitals in Andalusia&#44; Spain&#44; included in the extended use of dupilumab in Spain for adult patients with moderate to severe AD&#44; for 52 weeks&#46; The included population presented a significant disease load&#44; with a mean time of 28&#46;5 years since onset of the AD&#46; The most frequent comorbidities in the baseline visit were allergic rhinitis &#40;50&#37;&#41;&#44; conjunctivitis &#40;38&#46;8&#37;&#41;&#44; and extrinsic asthma &#40;22&#46;2&#37;&#41;&#46; All patients had received prior treatment with oral corticosteroids and 94&#46;4&#37; had been treated with cyclosporin&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The safety profile of dupilumab was evaluated at 4&#44; 12&#44; 24&#44; and 52 weeks&#46; The most frequent AE was conjunctivitis&#44; with 5 &#40;16&#37;&#41; reported cases&#46; Other AE were cheilitis&#44; a mild episode of AD&#44; unilateral gynecomastia&#44; and mouth ulcers&#46; All the AEs were transitory and were successfully managed without the need to withdraw the drug&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">With regard to the effectiveness of treatment with dupilumab&#44; in the baseline visit&#44; the mean score was 59&#46;4 on SCORAD scale&#44; 8&#46;3 on the pruritus VAS&#44; and 19 on the DLQI&#46; At week 52 of follow-up&#44; the SCORAD score was 10&#46;5 &#40;a reduction of 82&#46;3&#37; compared to baseline&#41;&#44; the pruritus VAS fell to 2&#46;1 &#40;a reduction of 74&#46;4&#37; compared to baseline&#41;&#44; and the DLQI fell to 2 &#40;a reduction of 89&#46;5&#37; compared to baseline&#41;&#46; The results at the different cutoff points are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The clinical safety and the efficacy of dupilumab in our series were in line with those observed in the clinical trials&#46; Conjunctivitis was considered to be the most frequent AE&#44; but was treated by the dermatologists taking part in this study with ophthalmic corticosteroid eye drops and suspension of treatment was not required&#46; Further&#44; more extensive studies are required&#44; with greater follow-up of the relationship between conjunctivitis and dupilumab to clarify its potential but ambiguous causal relationship&#44; as this adverse event was not observed in studies of dupilumab for other indications&#44; and it may be exclusive to the population with AD and&#44; therefore&#44; linked to the pathophysiology of the disease&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">This study has not received funding of any kind&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline &#40;n&#8239;&#61;&#8239;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 4 &#40;n&#8239;&#61;&#8239;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 12 &#40;n&#8239;&#61;&#8239;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 24 &#40;n&#8239;&#61;&#8239;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 52 &#40;n&#8239;&#61;&#8239;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SCORAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pruritus VAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DLQI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
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ISSN: 15782190
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?