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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Aquagenic pruritus &#40;AP&#41; is characterized by the onset of pruritus after contact with water&#44; with no evident skin lesions unlike aquagenic urticaria&#46; It is an uncommon condition in Spain&#44; but it can affect up to 20&#37; of young adults in African countries&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The disease may have a major negative impact on quality of life<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and management is difficult&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> One of the most effective treatments is phototherapy&#44; but relapses are frequent and maintenance therapy is required&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Cases have been reported in which an annual cycle of UVA and narrow-band UVB combination therapy &#40;UVA&#47;NB-UVB CT&#41; achieved good outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Our objective was to assess response to annual cycles of UVA&#47;NB-UVB CT in patients with AP refractory to antihistamine agents&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Long-term clinical response was retrospectively analyzed in patients with AP refractory to high doses of antihistamine agents treated with UVA&#47;NB-UVB CT in a reference hospital in Barcelona&#44; Spain&#44; between January 2010 and January 2019&#46; Two women aged 52 and 31 years were identified&#46; The case of patient 1 had been reported previously<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#59; her mother also had AP&#46; Patient 2 had celiac disease&#46; In both cases&#44; symptoms had presented more than 5 years previously and the patients had received multiple treatments &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Laboratory tests &#40;hemogram&#44; erythrocyte sedimentation rate&#44; creatinine levels&#44; liver and lipid profile&#41; were normal in both patients&#44; except for a small increase in IgE&#46; They were treated with UVA&#47;NB-UVB CT 3 times a week &#40;17&#8211;34 sessions a year&#41;&#46; The starting doses were 4&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 200&#8239;mJ&#47;cm<span class="elsevierStyleSup">2</span> &#40;NB-UVB&#41;&#46; The maximum doses were 9&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 1&#46;2&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;NB-UVB&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Patient 1 presented complete and prolonged response&#44; remaining free of symptoms for more than 5 years with an annual cycle of UVA&#47;NB-UVB CT &#40;17&#8211;26 sessions before the beginning of the summer&#44; 4 cycles in total&#41;&#46; The second patient completed 36 sessions of UVA&#47;NB-UVB CT during the first year&#44; with no clinical improvement&#44; and so phototherapy was discontinued&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">AP is generally idiopathic&#44; although up to 30&#37; of cases have been associated with hematological conditions such as polycythemia vera or myelodysplasia&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and 25&#37; of cases may be associated with lactose intolerance&#46; Other known associations include neoplasms&#44; hepatitis C&#44; and drugs such as bupropion and antimalarial agents&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Idiopathic AP occurs more frequently in young women and has a longer duration than AP with a known cause&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> AP may seriously impact activities of daily living&#59; it has been reported that up to 8&#37; of patients may develop phobia of washing&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> One of our patients avoided getting her legs wet for fear of triggering pruritus and burning sensation&#46; The pathophysiology of AP is not fully understood&#44; although it is thought there is increased skin innervation with dysfunctional and hyperexcitable C-nerve fibers&#44; probably caused by defective sodium channels&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The role of histamine is minimal&#44; thus explaining the limited response to antihistamine agents&#46; Treatment of AP is complex and&#44; often&#44; outcomes are disappointing for both the physician and the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Different topical treatments have been used such as increasing the pH of water with sodium bicarbonate&#44; capsaicin&#44; and glycerol trinitrate&#46; Oral drugs such as antihistamine agents&#44; pregabalin&#44; acetylsalicylic acid&#44; beta blockers &#40;propranolol&#44; atenolol&#41;&#44; and antidepressant drugs&#44; among others have been tried &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> There have also been reports of patients treated with interferon and omalizumab&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Phototherapy is one of the most effective treatment modalities&#44; including psoralene plus UVA &#40;PUVA&#41; and UVB&#46; However&#44; this is not curative and requires maintenance therapy to achieve symptomatic remission&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This can be problematic with PUVA&#44; given its carcinogenic potential&#46; NB-UVB has a better safety profile&#44; but evidence for its use in AP is very limited&#44; with only 3 case reports available&#46; In all cases&#44; it was effective in inducing remission&#46; In 2 patients&#44; a weekly dose was required to maintain clinical response for 4 and 6 months&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This regimen is associated with substantial logistic issues and expense&#46; The third patient relapsed after suspending phototherapy and this was discontinued&#59; propranolol was initiated with good response&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Including our patients&#44; there are 3 cases reported of treatment with UVA&#47;NB-UVB CT in which an annual cycle is used as maintenance therapy&#44; with excellent response in 2 of them<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> while 1 case was refractory&#46; Phototherapy probably acts as a neuromodulator&#44; reducing the density of skin nerve fibers and levels of neural growth factors&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> in addition to its well-established immunomodulatory effect&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment of AP is difficult&#46; We have reported a new case of treatment with UVA&#47;NB-UVB CT&#44; without clinical response&#44; and long-term follow-up of a female patient treated for more than 5 years &#40;4 cycles of UVA&#47;NB-UVB CT&#41; with complete remission of symptoms&#46; Cycles of UVA&#47;NB-UVB CT once a year may be a good alternative for long-term management of some patients with refractory AP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study did not receive any funding&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Morgado-Carrasco D&#44; Riera-Monroig J&#44; Feola H&#44; Aguilera P&#46; Tratamiento de 2 pacientes con prurito acuag&#233;nico con ciclos de terapia combinada UVA&#47;UVB de banda estrecha una vez por a&#241;o&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;889&#8211;892&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
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            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; F&#44; female&#59; NB UVB&#44; narrow-band UVB&#59; UVA&#47;NB-UVB CT&#44; UVA&#47;narrow-band UVB combined therapy&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Case&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">Sex&#47;Age&#44; y&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">Comorbidities&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">Family History&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">Duration of Symptoms&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">Prior Treatments&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">UVA&#47;NB-UVB CT Induction Dose&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">Number of Sessions&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">Maximum Dose&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">Total Number of Cycles of UVA&#47;NB-UVB CT&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">Clinical Response&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">1&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">F&#47;52&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">No&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">Yes&#44; mother with aquagenic pruritus&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; 5 years&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">Antihistamines&#44; montelukast&#44; beta-carotene&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&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 200&#8239;mJ&#47;cm<span class="elsevierStyleSup">2</span> &#40;NB-UVB&#41;&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 to 26&#47;year&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">9&#8239;J&#47;cm<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;UVA&#41; and 1&#46;2&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&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&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">Complete&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">2&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">F&#47;31&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">Celiac disease&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">No&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; 5 years&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">Antihistamines&#44; montelukast&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&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 200&#8239;mJ&#47;cm<span class="elsevierStyleSup">2</span> &#40;NB-UVB&#41;&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">36&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&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 1&#46;2&#8239;mJ&#47;cm<span class="elsevierStyleSup">2</span>&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&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">No clinical response <a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The maximum dose of UVA was 9&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> the first year&#44; and in the following cycles&#44; it did not exceed 5&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#46; The total dose after 4 cycles of UVA&#47;NB-UVB CT was 266&#46;5&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 89&#46;6&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;NB-UVB&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Patient 2 discontinued phototherapy after 36 sessions and has not repeated treatment&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and Epidemiological Characteristics and Therapeutic Response of Patients With Aquagenic Pruritus in UVA and Narrow-Band UVB Combination Therapy&#46;</p>"
        ]
      ]
      1 => array:9 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; Heitkemper et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Cao et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Murphy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>"
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          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Table "
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; UVA&#47;NB-UVB CT&#44; UVA&#47;narrow-band UVB combined therapy&#59; NB UVB&#44; narrow band UVB&#59; PUVA&#44; psoralene with UVA&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Route of Administration&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">Agent&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">Topical&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">Increased bath pH &#40;pH 8&#41; with sodium bicarbonate &#40;0&#46;1&#8722;0&#46;6&#8239;kg&#47;bath&#41;Capsaicin &#40;0&#46;025&#37; to 1&#37; 3 times a day for 4 weeks&#41;Glycerol trinitrate 2&#37; gelTransdermal scopolamine 3&#37; or 9&#37; in water&#44; acetone&#44; or ethanol before bathing&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">Oral&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">Antihistamines &#40;hydroxyzine&#44; astemizole&#44; chlorpheniramine&#44; cetirizine&#44; loratadine&#44; fexofenadine&#44; terfenadine&#41;H2 blockers &#40;cimetidine 900&#8239;mg&#47;d&#41;Acetylsalicylic acid 300&#8722;500&#8239;mg&#47;dPregabalin 150&#8722;300&#8239;mg&#47;dOpioid receptor antagonists &#40;naltrexone 25&#8722;50&#8239;mg&#47;d&#41;Serotonin reuptake inhibitors &#40;paroxetine 20&#8239;mg&#47;d&#44; fluoxetine 10&#8239;mg&#47;d&#41;Interferon-&#945; 2b &#40;week 1&#58; 5&#8239;&#215;&#8239;3 thousand IU&#44; week 2&#8722;4&#58; 3&#8239;&#215;&#8239;3 thousand IU&#41;Beta blockers &#40;propranolol 10&#8239;mg&#47;d&#44; 20&#8722;30&#8239;min before bathing&#44; or 60&#8239;mg&#47;d and atenolol 25&#8239;mg&#47;d&#41;CholestyramineMontelukast&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">Intramuscular&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">Triamcinolone&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">Subcutaneous&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">Omalizumab &#40;300&#8239;mg every 4 weeks&#41;&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">Others&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">Transcutaneous electrical nerve stimulationUse of tight-fitting Lycra clothing&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">Phototherapy&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">PUVAUVBNB-UVBUVA&#47;NB-UVB CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2469264.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Drugs and Different Agents Used in the Treatment of Aquagenic Pruritus&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and characteristics of aquagenic pruritus in a young African population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46;A&#46; Salami"
                            1 => "S&#46;O&#46; Samuel"
                            2 => "K&#46;C&#46; Eze"
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Case and Research Letters
Treatment of 2 Patients With Aquagenic Pruritus With UVA/Narrow Band UVB Combined Therapy Once a Year
Tratamiento de 2 pacientes con prurito acuagénico con ciclos de terapia combinada UVA/UVB de banda estrecha una vez por año
D. Morgado-Carrasco
Corresponding author
morgadodaniel8@gmail.com

Corresponding author.
, J. Riera-Monroig, H. Feola, P. Aguilera
Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
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    "titulo" => "Treatment of 2 Patients With Aquagenic Pruritus With UVA&#47;Narrow Band UVB Combined Therapy Once a Year"
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            "entidad" => "Dermatology Department&#44; Hospital Cl&#237;nic de Barcelona&#44; Universitat de Barcelona&#44; Spain"
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      "es" => array:1 [
        "titulo" => "Tratamiento de 2 pacientes con prurito acuag&#233;nico con ciclos de terapia combinada UVA&#47;UVB de banda estrecha una vez por a&#241;o"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Aquagenic pruritus &#40;AP&#41; is characterized by the onset of pruritus after contact with water&#44; with no evident skin lesions unlike aquagenic urticaria&#46; It is an uncommon condition in Spain&#44; but it can affect up to 20&#37; of young adults in African countries&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The disease may have a major negative impact on quality of life<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and management is difficult&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> One of the most effective treatments is phototherapy&#44; but relapses are frequent and maintenance therapy is required&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Cases have been reported in which an annual cycle of UVA and narrow-band UVB combination therapy &#40;UVA&#47;NB-UVB CT&#41; achieved good outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Our objective was to assess response to annual cycles of UVA&#47;NB-UVB CT in patients with AP refractory to antihistamine agents&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Long-term clinical response was retrospectively analyzed in patients with AP refractory to high doses of antihistamine agents treated with UVA&#47;NB-UVB CT in a reference hospital in Barcelona&#44; Spain&#44; between January 2010 and January 2019&#46; Two women aged 52 and 31 years were identified&#46; The case of patient 1 had been reported previously<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#59; her mother also had AP&#46; Patient 2 had celiac disease&#46; In both cases&#44; symptoms had presented more than 5 years previously and the patients had received multiple treatments &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Laboratory tests &#40;hemogram&#44; erythrocyte sedimentation rate&#44; creatinine levels&#44; liver and lipid profile&#41; were normal in both patients&#44; except for a small increase in IgE&#46; They were treated with UVA&#47;NB-UVB CT 3 times a week &#40;17&#8211;34 sessions a year&#41;&#46; The starting doses were 4&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 200&#8239;mJ&#47;cm<span class="elsevierStyleSup">2</span> &#40;NB-UVB&#41;&#46; The maximum doses were 9&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 1&#46;2&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;NB-UVB&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Patient 1 presented complete and prolonged response&#44; remaining free of symptoms for more than 5 years with an annual cycle of UVA&#47;NB-UVB CT &#40;17&#8211;26 sessions before the beginning of the summer&#44; 4 cycles in total&#41;&#46; The second patient completed 36 sessions of UVA&#47;NB-UVB CT during the first year&#44; with no clinical improvement&#44; and so phototherapy was discontinued&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">AP is generally idiopathic&#44; although up to 30&#37; of cases have been associated with hematological conditions such as polycythemia vera or myelodysplasia&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and 25&#37; of cases may be associated with lactose intolerance&#46; Other known associations include neoplasms&#44; hepatitis C&#44; and drugs such as bupropion and antimalarial agents&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Idiopathic AP occurs more frequently in young women and has a longer duration than AP with a known cause&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> AP may seriously impact activities of daily living&#59; it has been reported that up to 8&#37; of patients may develop phobia of washing&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> One of our patients avoided getting her legs wet for fear of triggering pruritus and burning sensation&#46; The pathophysiology of AP is not fully understood&#44; although it is thought there is increased skin innervation with dysfunctional and hyperexcitable C-nerve fibers&#44; probably caused by defective sodium channels&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The role of histamine is minimal&#44; thus explaining the limited response to antihistamine agents&#46; Treatment of AP is complex and&#44; often&#44; outcomes are disappointing for both the physician and the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Different topical treatments have been used such as increasing the pH of water with sodium bicarbonate&#44; capsaicin&#44; and glycerol trinitrate&#46; Oral drugs such as antihistamine agents&#44; pregabalin&#44; acetylsalicylic acid&#44; beta blockers &#40;propranolol&#44; atenolol&#41;&#44; and antidepressant drugs&#44; among others have been tried &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> There have also been reports of patients treated with interferon and omalizumab&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Phototherapy is one of the most effective treatment modalities&#44; including psoralene plus UVA &#40;PUVA&#41; and UVB&#46; However&#44; this is not curative and requires maintenance therapy to achieve symptomatic remission&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This can be problematic with PUVA&#44; given its carcinogenic potential&#46; NB-UVB has a better safety profile&#44; but evidence for its use in AP is very limited&#44; with only 3 case reports available&#46; In all cases&#44; it was effective in inducing remission&#46; In 2 patients&#44; a weekly dose was required to maintain clinical response for 4 and 6 months&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This regimen is associated with substantial logistic issues and expense&#46; The third patient relapsed after suspending phototherapy and this was discontinued&#59; propranolol was initiated with good response&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Including our patients&#44; there are 3 cases reported of treatment with UVA&#47;NB-UVB CT in which an annual cycle is used as maintenance therapy&#44; with excellent response in 2 of them<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> while 1 case was refractory&#46; Phototherapy probably acts as a neuromodulator&#44; reducing the density of skin nerve fibers and levels of neural growth factors&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> in addition to its well-established immunomodulatory effect&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment of AP is difficult&#46; We have reported a new case of treatment with UVA&#47;NB-UVB CT&#44; without clinical response&#44; and long-term follow-up of a female patient treated for more than 5 years &#40;4 cycles of UVA&#47;NB-UVB CT&#41; with complete remission of symptoms&#46; Cycles of UVA&#47;NB-UVB CT once a year may be a good alternative for long-term management of some patients with refractory AP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study did not receive any funding&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2019-02-04"
    "fechaAceptado" => "2019-02-17"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Morgado-Carrasco D&#44; Riera-Monroig J&#44; Feola H&#44; Aguilera P&#46; Tratamiento de 2 pacientes con prurito acuag&#233;nico con ciclos de terapia combinada UVA&#47;UVB de banda estrecha una vez por a&#241;o&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;889&#8211;892&#46;</p>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; F&#44; female&#59; NB UVB&#44; narrow-band UVB&#59; UVA&#47;NB-UVB CT&#44; UVA&#47;narrow-band UVB combined therapy&#46;</p>"
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                  \t\t\t\t\ttable-head\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">Family History&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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration of Symptoms&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">Prior Treatments&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">UVA&#47;NB-UVB CT Induction Dose&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">Number of Sessions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\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">Maximum Dose&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">Total Number of Cycles of UVA&#47;NB-UVB CT&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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical Response&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
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                  \t\t\t\t">1&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">F&#47;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Yes&#44; mother with aquagenic pruritus&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">&#62; 5 years&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">Antihistamines&#44; montelukast&#44; beta-carotene&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 200&#8239;mJ&#47;cm<span class="elsevierStyleSup">2</span> &#40;NB-UVB&#41;&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 to 26&#47;year&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">9&#8239;J&#47;cm<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;UVA&#41; and 1&#46;2&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \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">Celiac disease&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">No&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; 5 years&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">Antihistamines&#44; montelukast&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&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 200&#8239;mJ&#47;cm<span class="elsevierStyleSup">2</span> &#40;NB-UVB&#41;&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">36&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&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 1&#46;2&#8239;mJ&#47;cm<span class="elsevierStyleSup">2</span>&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&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">No clinical response <a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The maximum dose of UVA was 9&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> the first year&#44; and in the following cycles&#44; it did not exceed 5&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#46; The total dose after 4 cycles of UVA&#47;NB-UVB CT was 266&#46;5&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;UVA&#41; and 89&#46;6&#8239;J&#47;cm<span class="elsevierStyleSup">2</span> &#40;NB-UVB&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Patient 2 discontinued phototherapy after 36 sessions and has not repeated treatment&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and Epidemiological Characteristics and Therapeutic Response of Patients With Aquagenic Pruritus in UVA and Narrow-Band UVB Combination Therapy&#46;</p>"
        ]
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      1 => array:9 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "fuente" => "Source&#58; Heitkemper et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Cao et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Murphy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; UVA&#47;NB-UVB CT&#44; UVA&#47;narrow-band UVB combined therapy&#59; NB UVB&#44; narrow band UVB&#59; PUVA&#44; psoralene with UVA&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Route of Administration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\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">Agent&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">Topical&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">Increased bath pH &#40;pH 8&#41; with sodium bicarbonate &#40;0&#46;1&#8722;0&#46;6&#8239;kg&#47;bath&#41;Capsaicin &#40;0&#46;025&#37; to 1&#37; 3 times a day for 4 weeks&#41;Glycerol trinitrate 2&#37; gelTransdermal scopolamine 3&#37; or 9&#37; in water&#44; acetone&#44; or ethanol before bathing&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">Oral&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">Antihistamines &#40;hydroxyzine&#44; astemizole&#44; chlorpheniramine&#44; cetirizine&#44; loratadine&#44; fexofenadine&#44; terfenadine&#41;H2 blockers &#40;cimetidine 900&#8239;mg&#47;d&#41;Acetylsalicylic acid 300&#8722;500&#8239;mg&#47;dPregabalin 150&#8722;300&#8239;mg&#47;dOpioid receptor antagonists &#40;naltrexone 25&#8722;50&#8239;mg&#47;d&#41;Serotonin reuptake inhibitors &#40;paroxetine 20&#8239;mg&#47;d&#44; fluoxetine 10&#8239;mg&#47;d&#41;Interferon-&#945; 2b &#40;week 1&#58; 5&#8239;&#215;&#8239;3 thousand IU&#44; week 2&#8722;4&#58; 3&#8239;&#215;&#8239;3 thousand IU&#41;Beta blockers &#40;propranolol 10&#8239;mg&#47;d&#44; 20&#8722;30&#8239;min before bathing&#44; or 60&#8239;mg&#47;d and atenolol 25&#8239;mg&#47;d&#41;CholestyramineMontelukast&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">Intramuscular&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">Triamcinolone&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">Subcutaneous&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">Omalizumab &#40;300&#8239;mg every 4 weeks&#41;&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">Others&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">Transcutaneous electrical nerve stimulationUse of tight-fitting Lycra clothing&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">Phototherapy&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">PUVAUVBNB-UVBUVA&#47;NB-UVB CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Drugs and Different Agents Used in the Treatment of Aquagenic Pruritus&#46;</p>"
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      "titulo" => "References"
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          "bibliografiaReferencia" => array:10 [
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              "identificador" => "bib0005"
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                      "autores" => array:1 [
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                          "etal" => false
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Article information
ISSN: 15782190
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
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