Case and Research Letters
Residual Pigment Islands Treated With 88% Phenol Peeling in a Woman With Universal Vitiligo
Islotes de pigmentación residual en paciente con vitiligo universal, tratados con peeling de fenol al 88%
a Universidad Autónoma de Barcelona, Clínica Dermatológica Moragas, Barcelona, Spain
b Universidad Central de Venezuela, Cursante del Máster de Dermatología Avanzada de la Universidad Autónoma de Barcelona, Barcelona, Spain
c Faculdade de Medicina do ABC, Cursante del Máster de Dermatología Avanzada de la Universidad Autónoma de Barcelona, Barcelona, Spain
Read
5275
Timeswas read the article
1670
Total PDF
3605
Total HTML
Share statistics
array:24 [ "pii" => "S1578219021000226" "issn" => "15782190" "doi" => "10.1016/j.adengl.2021.01.018" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "2451" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2021;112:284-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731020303161" "issn" => "00017310" "doi" => "10.1016/j.ad.2020.01.002" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "2451" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2021;112:284-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICO-CLÍNICA</span>" "titulo" => "Islotes de pigmentación residual en paciente con vitiligo universal, tratados con <span class="elsevierStyleItalic">peeling</span> de fenol al 88%" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "284" "paginaFinal" => "285" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Residual Pigment Islands Treated With 88% Phenol Peeling in a Woman With Universal Vitiligo" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 741 "Ancho" => 805 "Tamanyo" => 77914 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Postratamiento.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Alomar, M. Marrón Hernández, F. Bittencourt" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Alomar" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Marrón Hernández" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Bittencourt" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219021000226" "doi" => "10.1016/j.adengl.2021.01.018" "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/S1578219021000226?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731020303161?idApp=UINPBA000044" "url" => "/00017310/0000011200000003/v1_202103020647/S0001731020303161/v1_202103020647/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S157821902100010X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2021.01.009" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "2379" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2021;112:285-7" "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 and Research Letters</span>" "titulo" => "Allergic Contact Dermatitis Due to Slime" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "285" "paginaFinal" => "287" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis alérgica de contacto por <span class="elsevierStyleItalic">slime</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 839 "Ancho" => 1255 "Tamanyo" => 136898 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Handling slime (Source: Getty Images).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Córdoba, M. Blanco-Calvo, A. Huerta-Vena, J. Borbujo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Córdoba" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Blanco-Calvo" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Huerta-Vena" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Borbujo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731020301769" "doi" => "10.1016/j.ad.2020.03.006" "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/S0001731020301769?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821902100010X?idApp=UINPBA000044" "url" => "/15782190/0000011200000003/v1_202103020923/S157821902100010X/v1_202103020923/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S1578219021000202" "issn" => "15782190" "doi" => "10.1016/j.adengl.2021.01.016" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "2377" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2021;112:282-3" "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 and Research Letters</span>" "titulo" => "Becker Nevus: 4 Cases of a Rare Syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "282" "paginaFinal" => "283" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome del nevo de Becker. Cuatro casos de una rara entidad" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 506 "Ancho" => 755 "Tamanyo" => 46686 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hyperpigmented macule on the right scapular region and shoulder, present since birth. The comedones and hair on the macule appeared at puberty.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.L. Tirelli, A. Label, P.C. Luna, M. Larralde" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L.L." "apellidos" => "Tirelli" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Label" ] 2 => array:2 [ "nombre" => "P.C." "apellidos" => "Luna" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Larralde" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731020301745" "doi" => "10.1016/j.ad.2019.11.007" "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/S0001731020301745?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021000202?idApp=UINPBA000044" "url" => "/15782190/0000011200000003/v1_202103020923/S1578219021000202/v1_202103020923/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Residual Pigment Islands Treated With 88% Phenol Peeling in a Woman With Universal Vitiligo" "tieneTextoCompleto" => true "saludo" => "To the Editor" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "284" "paginaFinal" => "285" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Alomar, M. Marrón Hernández, F. Bittencourt" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Alomar" "email" => array:1 [ 0 => "Agustin.alomar@quironsalud.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Marrón Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Bittencourt" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Universidad Autónoma de Barcelona, Clínica Dermatológica Moragas, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad Central de Venezuela, Cursante del Máster de Dermatología Avanzada de la Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Faculdade de Medicina do ABC, Cursante del Máster de Dermatología Avanzada de la Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Islotes de pigmentación residual en paciente con vitiligo universal, tratados con <span class="elsevierStyleItalic">peeling</span> de fenol al 88%" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 779 "Ancho" => 755 "Tamanyo" => 65654 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Before treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Vitiligo is a depigmenting skin disease with a global prevalence of 1%. While multiple therapeutic options exist, none of them is completely satisfactory, especially in universal vitiligo, where depigmentation of the residual areas of pigment using chemical methods, such as hydroquinone monobenzyl ether (HMBE), may be cosmetically acceptable, as it produces complete, almost irreversible depigmentation. Other depigmenting substances exist, however, such as phenol, have been described previously but with little clinical evidence.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 67-year-old woman with vitiligo that had appeared in childhood and was universally distributed since 14 years earlier visited our department seeking alternative depigmenting therapeutic options, as she presented areas of residual pigmentation on the face, chest, and shoulders, which had not responded to prior treatment with HMBE (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">An 88% aqueous solution of phenol was applied selectively, starting on the pigmented areas on the right cheek, as they were small areas that minimized systemic absorption, toxicity, and adverse effects. This was achieved by evaluating the response and tolerance of the patients and by applying cold compresses to alleviate pain immediately after frosting was observed. Given the good response, 4 applications were performed on the same section, achieving complete depigmentation, and the same procedure was performed on the other pigmented areas with excellent results and no evidence of repigmentation until 1 year after the procedure; the patient, who complied strictly with photoprotection, was very satisfied (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The melanotoxic effects of phenol have been previously documented, but its depigmenting mechanism of action appears to be complex. The common characteristic of these products is their chemical structure, which includes a phenol group made up of a benzene ring with a hydroxyl side chain, a structure that is shared with the amino acid tyrosine. Potent phenols act as tyrosine analogs, interfering with the melanogenesis pathway, and initial hypotheses suggested that depigmenting chemicals that entered the melanogenesis pathway generated toxic metabolites that destroy the melanocytes. Tyrosine and other enzymes of melanogenesis bind covalently to phenols, as does tyrosine, generating reactive oxygen species and activating the response of the proteins released, autophagy, and exosomes, which supply adjacent immune cells with new antigens, initiate an inflammatory response, and activate autoreactive T cells, thus initiating an autoimmune response that results in their destruction.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">They also induce glutathione depletion, which may increase the immunogenicity of melanosomal proteins. The pigmented cells exposed to phenol activate specific T cells, also reacting against other melanocytes not directly stressed by exposure. This would explain depigmentation at a distance from these compounds through a mechanism analogous to that which occurs in contact sensitization.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The use of phenol has not been described previously in guidelines on the management of vitiligo, even though its use may be safe and economically viable. In Brazil, however, it has been introduced successfully in clinical practice at a concentration of 88%, as a depigmenting therapy for universal vitiligo; nevertheless, a case reported in Iran obtained no response to single-drug therapy with phenol and treatment was supplemented with cryotherapy.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Phenol is an aromatic hydrocarbon derived from coal tar and is used as a chemical peeling agent. Its effect varies depending on the concentration and the surface area to which it is applied. Concentrations above 80% produce denaturalization and rapid and irreversible coagulation of epidermal proteins, resulting in the formation of a barrier that prevents the chemical from penetrating the deep dermis, whereas when diluted to 50%, it acts as a keratolytic agent and disrupts the sulfur bridges, thus increasing its penetration beyond the dermis and causing greater destruction and systemic absorption.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Complications may include scarring, dyschromia, and eczema herpeticum. High doses are toxic, and it must not, therefore, be applied over large areas, given that it has a marked corrosive action, either due to ingestion, inhalation, or direct contact. Cellular uptake is rapid and passive due to its lipophilic nature and signs of systemic toxicity appear shortly after exposure. Target organs are the liver, kidneys, lungs, and cardiovascular system. When used by qualified experts, however, it does not usually cause complications. Repigmentation of the skin may occur if patients do not protect themselves adequately from the sun.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Although the only treatment currently approved by the US Food and Drugs Administration (FDA) for vitiligo is HMBE, few published cases describing the efficacy of phenol and isolated studies demonstrating its mechanism of action exist. Our patient presented a satisfactory response to the selective application of 88% phenol, with no complications and no relapse; we therefore consider it to be an excellent depigmenting therapeutic option in universal vitiligo with areas of pigmentation that do not respond to HMBE.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">This study has not received funding of any kind.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-07-30" "fechaAceptado" => "2020-01-13" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alomar A, Marrón Hernández M, Bittencourt F. Islotes de pigmentación residual en paciente con vitiligo universal, tratados con <span class="elsevierStyleItalic">peeling</span> de fenol al 88%. Actas Dermosifiliogr. 2021;112:284–285.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 779 "Ancho" => 755 "Tamanyo" => 65654 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Before treatment.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 741 "Ancho" => 805 "Tamanyo" => 77914 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">After treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the management of vitiligo: the European Dermatology Forum consensus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Taieb" 1 => "A. Alomar" 2 => "M. Böhm" 3 => "M.L. Dell’Anna" 4 => "A. De Pase" 5 => "V. Eleftheriadou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2012.11197.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol." "fecha" => "2013" "volumen" => "168" "paginaInicial" => "5" "paginaFinal" => "19" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22860621" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemical-induced vitiligo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Harris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.det.2016.11.006" "Revista" => array:6 [ "tituloSerie" => "Dermatol Clin." "fecha" => "2018" "volumen" => "35" "paginaInicial" => "151" "paginaFinal" => "161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28317525" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Depigmentation therapies for vitiligo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.E. Grimes" 1 => "R. Nashawati" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.det.2016.11.010" "Revista" => array:6 [ "tituloSerie" => "Dermatol Clin." "fecha" => "2017" "volumen" => "35" "paginaInicial" => "219" "paginaFinal" => "227" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28317530" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanism of action of 4‐substituted phenols to induce vitiligo and anti‐melanoma immunity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Kammeyer" 1 => "K.J. Willemsen" 2 => "W. Ouwerkerk" 3 => "W.J. Bakker" 4 => "D. Ratsma" 5 => "S.D. Pronk" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Pigment Cell Melanoma Res." "fecha" => "2019" "paginaInicial" => "0" "paginaFinal" => "2" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Depigmentation therapy for generalized vitiligo with topical 88% phenol solution" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Zanini" 1 => "C.D.A.S. Machado Filho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Bras Dermatol." "fecha" => "2005" "volumen" => "80" "paginaInicial" => "415" "paginaFinal" => "416" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case Report Induction of depigmentation in a universal vitiligo patient with combination of cryotherapy and phenol" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Kavuossi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pakistan Assoc Dermatologists." "fecha" => "2009" "volumen" => "19" "paginaInicial" => "112" "paginaFinal" => "114" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemical peels: a review of current practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.A. O’Connor" 1 => "P.M. Lowe" 2 => "S. Shumack" 3 => "A.C. Lim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ajd.12715" "Revista" => array:6 [ "tituloSerie" => "Australas J Dermatol." "fecha" => "2018" "volumen" => "59" "paginaInicial" => "171" "paginaFinal" => "181" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29064096" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Depigmentation therapies in vitiligo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Gupta" 1 => "R. Kumari" 2 => "D.M. Thappa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Indian J Dermatology, Venereol Leprol." "fecha" => "2012" "volumen" => "78" "paginaInicial" => "49" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011200000003/v1_202103020923/S1578219021000226/v1_202103020923/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011200000003/v1_202103020923/S1578219021000226/v1_202103020923/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021000226?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 20 | 8 | 28 |
| 2024 October | 104 | 46 | 150 |
| 2024 September | 105 | 45 | 150 |
| 2024 August | 139 | 51 | 190 |
| 2024 July | 119 | 37 | 156 |
| 2024 June | 118 | 39 | 157 |
| 2024 May | 109 | 34 | 143 |
| 2024 April | 98 | 29 | 127 |
| 2024 March | 91 | 26 | 117 |
| 2024 February | 102 | 36 | 138 |
| 2024 January | 81 | 29 | 110 |
| 2023 December | 85 | 27 | 112 |
| 2023 November | 131 | 59 | 190 |
| 2023 October | 110 | 27 | 137 |
| 2023 September | 88 | 35 | 123 |
| 2023 August | 72 | 18 | 90 |
| 2023 July | 94 | 40 | 134 |
| 2023 June | 74 | 21 | 95 |
| 2023 May | 101 | 33 | 134 |
| 2023 April | 92 | 33 | 125 |
| 2023 March | 96 | 35 | 131 |
| 2023 February | 80 | 26 | 106 |
| 2023 January | 67 | 32 | 99 |
| 2022 December | 78 | 38 | 116 |
| 2022 November | 60 | 33 | 93 |
| 2022 October | 60 | 22 | 82 |
| 2022 September | 44 | 43 | 87 |
| 2022 August | 56 | 39 | 95 |
| 2022 July | 41 | 32 | 73 |
| 2022 June | 27 | 25 | 52 |
| 2022 May | 62 | 41 | 103 |
| 2022 April | 68 | 25 | 93 |
| 2022 March | 80 | 65 | 145 |
| 2022 February | 87 | 31 | 118 |
| 2022 January | 87 | 44 | 131 |
| 2021 December | 53 | 30 | 83 |
| 2021 November | 57 | 44 | 101 |
| 2021 October | 72 | 71 | 143 |
| 2021 September | 77 | 50 | 127 |
| 2021 August | 58 | 35 | 93 |
| 2021 July | 54 | 19 | 73 |
| 2021 June | 38 | 31 | 69 |
| 2021 May | 54 | 46 | 100 |
| 2021 April | 92 | 65 | 157 |
| 2021 March | 68 | 48 | 116 |
| 2021 February | 50 | 21 | 71 |
| 2021 January | 6 | 6 | 12 |
Show all
