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el incremento de la prevalencia de enfermedades neurol&#243;gicas&#44; y el incremento de los f&#225;rmacos asociados al desarrollo de PA&#44; en particular los inhibidores de dipeptidil peptidasa-IV &#40;DPP-4&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Diversas observaciones respaldan el rol patog&#233;nico de los eosin&#243;filos en el PA&#46; El infiltrado inflamatorio d&#233;rmico rico en eosin&#243;filos es una caracter&#237;stica histol&#243;gica destacada&#44; habi&#233;ndose documentado eosinofilia en sangre perif&#233;rica en el 50-60&#37; de los pacientes de PA<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Adem&#225;s&#44; los niveles de eosin&#243;filos en sangre perif&#233;rica y cut&#225;neos se han correlacionado con la gravedad de la enfermedad<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; Los eosin&#243;filos parecen ser c&#233;lulas efectoras clave para el inicio y la progresi&#243;n de PA&#46; De hecho&#44; el infiltrado de eosin&#243;filos cut&#225;neos es una caracter&#237;stica temprana&#44; que precede a la formaci&#243;n de ampollas<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a>&#46; La desgranulaci&#243;n de eosin&#243;filos y la liberaci&#243;n de trampas de eosin&#243;filos extracelulares y prote&#237;nas granulosas promueven la formaci&#243;n de lesiones<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">10&#44;11</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Aunque se va acumulando evidencia creciente sobre la contribuci&#243;n de los eosin&#243;filos a la patogenia de PA&#44; la influencia de los niveles de eosin&#243;filos circulantes y cut&#225;neos en el fenotipo de PA sigue sin comprenderse&#46; El objetivo principal de este estudio fue evaluar la asociaci&#243;n entre los niveles de eosin&#243;filos circulantes y cut&#225;neos y las caracter&#237;sticas cl&#237;nicas e inmunol&#243;gicas de la enfermedad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio de cohorte retrospectivo de todos los pacientes diagnosticados de PA entre el 1 de enero de 2011 y el 31 de diciembre de 2020&#44; en un centro de atenci&#243;n terciaria&#46; Dicho estudio fue aprobado por el Comit&#233; de &#201;tica local&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de PA fue establecido conforme a los criterios siguientes&#58; &#40;1&#41; visi&#243;n cl&#237;nica e histopatol&#243;gica sugestiva de PA&#59; &#40;2&#41; dep&#243;sitos lineales de IgG y&#47;o C3 a largo de la uni&#243;n d&#233;rmico-epid&#233;rmica mediante microscopio de inmunofluorescencia directa &#40;DIF&#41; de biopsia cut&#225;nea perilesional&#59; y &#40;3&#41; presencia de anticuerpos IgG circulantes anti-BP180 y&#47;o BP230&#44; identificada mediante ensayo por inmunoabsorci&#243;n ligado a enzimas BP180 NC16A&#47;BP230 &#40;ELISA&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Excluimos a todos los pacientes con causa alternativa de eosinofilia en sangre perif&#233;rica y tisular&#44; incluyendo dermatitis at&#243;pica&#44; asma&#44; rinitis al&#233;rgica&#44; infecci&#243;n parasitaria y linfoma&#46; Tambi&#233;n se excluy&#243; a todos los pacientes tratados con f&#225;rmacos que afectaran al recuento eosinof&#237;lico en el momento del diagn&#243;stico de PA&#44; incluyendo esteroides sist&#233;micos e inmunosupresores&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se revisaron los recuentos de eosin&#243;filos previos a la administraci&#243;n de cualquier tratamiento&#46; Se clasificaron los recuentos de eosin&#243;filos en sangre perif&#233;rica como&#58; normales si eran inferiores a 500 &#215; 10<span class="elsevierStyleSup">6</span>&#47;L&#44; altos si estaban comprendidos entre 500 y 1&#46;500 &#215; 10<span class="elsevierStyleSup">6</span>&#47;l&#44; y muy altos si superaban el valor de 1&#46;500 &#215; 10<span class="elsevierStyleSup">6</span>&#47;L&#46; Los niveles de autoanticuerpos IgG anti-BP180 NC16A y anti-BP230 en sangre perif&#233;rica fueron medidos mediante ELISA &#40;Euroimmun&#44; L&#369;beck&#44; Alemania&#41;&#46; Se determin&#243; la seropositividad sobre la base de los valores de corte propuestos por el fabricante &#40;es decir&#44; 20 U&#47;mL&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se revisaron muestras cut&#225;neas de la lesi&#243;n con tinci&#243;n hematoxilina y eosina &#40;H&#38;E&#41; en t&#233;rminos de niveles de eosin&#243;filos por parte de tres dermatopat&#243;logos &#40;MAG&#44; PEL&#44; LSA&#41;&#46; En cada muestra&#44; se identificaron puntos calientes representativos de una mayor densidad de eosin&#243;filos en el infiltrado inflamatorio d&#233;rmico&#46; Se recont&#243; el n&#250;mero de eosin&#243;filos en cada punto caliente utilizando un objetivo de paso alto &#250;nico &#215; 400 &#40;HPF&#41; &#40;un punto caliente de gran &#225;rea amplificada&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Los datos fueron analizados utilizando IBM SPSS Statistics&#174; &#40;Paquete Estad&#237;stico para Ciencias Sociales&#44; versi&#243;n 24&#44; IBM Corp&#46;&#44; Armonk&#44; NY&#44; EE&#46; UU&#46;&#41;&#46; Las variables categ&#243;ricas se presentaron como frecuencias y porcentajes&#44; compar&#225;ndose mediante la prueba &#967;<span class="elsevierStyleSup">2</span>&#46; Se analizaron los datos no normalmente distribuidos mediante la prueba <span class="elsevierStyleItalic">U</span> de Mann-Whitney para subgrupos independientes&#44; y las pruebas de Wilcoxon para subgrupos dependientes&#46; Las variables continuas se presentaron como medias y desviaciones est&#225;ndar&#46; Dichas variables fueron comparadas utilizando la prueba <span class="elsevierStyleItalic">t</span> de Student&#46; Todos los valores p reportados fueron bidireccionales&#44; siendo el valor 0&#44;05 indicativo de significaci&#243;n estad&#237;stica&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Caracter&#237;sticas descriptivas y comorbilidades de la poblaci&#243;n de estudio</span><p id="par0050" class="elsevierStylePara elsevierViewall">La cohorte del estudio incluy&#243; 233 pacientes con PA&#44; de los cuales 123 &#40;52&#44;8&#37;&#41; eran hombres&#46; La edad media &#40;DE&#41; en el momento del diagn&#243;stico fue de 79&#44;3 &#40;9&#44;3&#41; a&#241;os&#44; siendo la edad media de 81 a&#241;os &#40;rango 51-101&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En general&#44; 113 pacientes &#40;48&#44;5&#37;&#41; ten&#237;an diabetes mellitus de tipo 2 al iniciarse el PA&#46; Setenta y dos pacientes &#40;30&#44;9&#37;&#41; desarrollaron PA durante el tratamiento con inhibidores de DPP-4&#46; El inhibidor de DPP-4 m&#225;s frecuentemente descrito fue vildagliptina &#40;n &#61; 36&#59; 50&#37;&#41;&#44; seguido de linagliptina &#40;n &#61; 24&#59; 33&#44;3&#37;&#41; y sitagliptina &#40;n &#61; 12&#59; 16&#44;7&#37;&#41;&#46; El tiempo de latencia medio entre la introducci&#243;n del inhibidor de DPP-4 y el inicio de PA fue de 18 meses &#40;rango 4-96 meses&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Noventa y tres pacientes &#40;39&#44;9&#37;&#41; ten&#237;an enfermedad neurol&#243;gica concomitante&#46; La enfermedad neurol&#243;gica asociada m&#225;s com&#250;n fue la demencia &#40;n &#61; 48&#59; 20&#44;6&#37;&#41;&#44; seguida de la enfermedad cerebrovascular &#40;n &#61; 31&#59; 13&#44;3&#37;&#41;&#44; enfermedad de Parkinson &#40;n &#61; 16&#59; 6&#44;9&#37;&#41; y la epilepsia &#40;n &#61; 9&#59; 3&#44;9&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas descriptivas de los pacientes se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Asociaci&#243;n entre los niveles de eosin&#243;filos circulantes y cut&#225;neos y las caracter&#237;sticas del PA</span><p id="par0070" class="elsevierStylePara elsevierViewall">El recuento principal de eosin&#243;filos circulantes fue de 956&#44;3 &#177; 408&#44;6 &#215; 10<span class="elsevierStyleSup">6</span>&#47;L&#46; En el &#225;rea de puntos calientes cut&#225;neos&#44; el n&#250;mero medio de eosin&#243;filos fue de 30&#44;5 &#177; 19&#46; El n&#250;mero de eosin&#243;filos presentes en infiltrados d&#233;rmicos guard&#243; una relaci&#243;n directa con los niveles de eosin&#243;filos circulantes &#40;r &#61; 0&#44;234&#44; p &#61; 0&#44;004&#41;&#46; La relaci&#243;n entre los niveles de eosin&#243;filos en sangre perif&#233;rica e infiltrados d&#233;rmicos y las caracter&#237;sticas demogr&#225;ficas&#44; cl&#237;nicas e inmunol&#243;gicas de los pacientes de PA se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Los niveles de eosin&#243;filos de infiltrados d&#233;rmicos fueron significativamente superiores en los pacientes con PA acompa&#241;ado de enfermedad neurol&#243;gica &#40;p &#61; 0&#44;032&#41;&#46; Por contra&#44; los pacientes tratados con inhibidores DPP-4 ten&#237;an niveles considerablemente menores de eosin&#243;filos&#44; tanto en sangre perif&#233;rica como en el &#225;rea cut&#225;nea de puntos calientes &#40;p &#61; 0&#44;008&#59; p &#61; 0&#44;013&#44; respectivamente&#41;&#46;Con respecto a la distribuci&#243;n anat&#243;mica de las lesiones&#44; que presentaban una forma diseminada de PA &#40;es decir&#44; <span class="elsevierStyleItalic">body surface area</span> &#91;BSA&#93; &#62; 50&#37;&#41; fue considerablemente m&#225;s frecuente en el grupo de niveles de eosin&#243;filos circulantes &#40;p &#61; 0&#44;028&#41;&#46; Adem&#225;s&#44; el compromiso de pies y manos fue tambi&#233;n m&#225;s frecuente en este grupo &#40;p &#61; 0&#44;029&#41;&#46; El compromiso mucoso estuvo considerablemente asociado a un nivel de eosin&#243;filos m&#225;s bajo en el &#225;rea de puntos calientes del infiltrado d&#233;rmico &#40;p &#61; 0&#44;001&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Los niveles de anticuerpos IgG anti-BP180 NC16A guardaron una relaci&#243;n directa con los niveles de eosin&#243;filos circulantes y de infiltrados d&#233;rmicos &#40;r &#61; 0&#44;356&#44; p &#61; 0&#44;001&#59; r &#61; 0&#44;197&#44; p &#61; 0&#44;43&#44; respectivamente&#41;&#46; El nivel medio de anticuerpos IgG anti-BP180 NC16A fue significativamente superior en el grupo de niveles de eosin&#243;filos circulantes &#40;p &#60; 0&#44;001&#41;&#46; No se encontr&#243; correlaci&#243;n alguna con los anticuerpos IgG anti-BP230&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La necesidad de atenci&#243;n hospitalaria guard&#243; una relaci&#243;n significativa con el mayor nivel basal de eosin&#243;filos circulantes &#40;p &#61; 0&#44;025&#41;&#46; Adem&#225;s&#44; la recidiva fue tambi&#233;n m&#225;s frecuente en los pacientes con mayor nivel basal de eosin&#243;filo circulantes &#40;p &#61; 0&#44;020&#41;&#46; La mayor&#237;a de las recidivas se produjo dentro de los primeros seis meses del estudio &#40;n &#61; 56&#47;68&#59; 82&#44;4&#37;&#41;&#46; Entre los 68 pacientes que experimentaron recidiva de PA&#44; 19 ten&#237;an cifras altas y 12 cifras muy altas de eosin&#243;filos circulantes durante la reca&#237;da &#40;27&#44;9 y 16&#44;6&#37;&#44; respectivamente&#41;&#46; En dichos pacientes&#44; las cifras de eosin&#243;filos circulantes basales y durante la reca&#237;da guardaron una correlaci&#243;n significativa &#40;r &#61; 0&#44;82&#44; p &#60; 0&#44;001&#41;&#46; Muchos pacientes con recidiva y altos niveles basales de eosin&#243;filos circulantes presentaron tambi&#233;n eosinofilia en sangre perif&#233;rica en la recidiva &#40;n &#61; 22&#47;31&#59; 71&#37;&#41;&#46; Por contra&#44; solo dos pacientes sin cifras elevadas basales de eosin&#243;filos circulantes presentaron posteriormente eosinofilia en sangre perif&#233;rica durante la reca&#237;da &#40;n &#61; 2&#47;37&#59; 5&#44;4&#37;&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n</span><p id="par0090" class="elsevierStylePara elsevierViewall">El presente estudio revel&#243; que los niveles de eosin&#243;filos circulantes y cut&#225;neos est&#225;n asociados a la gravedad de PA y los resultados del tratamiento&#46; La eosinofilia en sangre perif&#233;rica se asoci&#243; tambi&#233;n a la enfermedad extensiva y al compromiso de pies y manos&#46; Adem&#225;s&#44; predijo un mayor riesgo de necesidad de atenci&#243;n hospitalaria y recidiva&#46; Los niveles de eosin&#243;filos circulantes y tisulares estuvieron asociados a altos t&#237;tulos de anticuerpos IgG anti-BP180 NC16A&#46; Los infiltrados inflamatorios bajos en eosin&#243;filos predijeron un incremento de la prevalencia de compromiso mucoso&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Los estudios previos hab&#237;an aportado conclusiones no concluyentes de la influencia de los niveles de eosin&#243;filos circulantes en las caracter&#237;sticas cl&#237;nicas e inmunol&#243;gicas de PA&#46; Tambi&#233;n se ha reflejado recientemente que los niveles de eosin&#243;filos circulantes guardaban una correlaci&#243;n positiva con los niveles circulantes de IgG e IgE anti-BP180 y la gravedad de la enfermedad<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;12</span></a>&#46; Kridin report&#243; que los pacientes con PA y eosinofilia ten&#237;an una mayor tasa de compromiso palmoplantar y extensi&#243;n de la enfermedad&#46; Por contra&#44; los pacientes con niveles normales de eosin&#243;filos tend&#237;an a tener caracter&#237;sticas cl&#237;nicas at&#237;picas&#44; incluyendo mayor compromiso en mucosa y cabeza&#47;cuello<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Aunque un infiltrado inflamatorio rico en eosin&#243;filos es una caracter&#237;stica bien conocida de PA&#44; la relaci&#243;n entre los niveles tisulares de eosin&#243;filos y la presentaci&#243;n del PA est&#225; tambi&#233;n bien establecida&#46; Izumi et al&#46; mostraron que los pacientes que acudieron con un fenotipo inflamatorio con eritema y placas urticarianas ten&#237;an una seropositividad incrementada de IgG anti-BP180 NC16A y un n&#250;mero elevado de eosin&#243;filos infiltrantes en las secciones cut&#225;neas de la lesion<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a>&#46; Adem&#225;s&#44; tambi&#233;n se hab&#237;an correlacionado recientemente los niveles tisulares de eosin&#243;filos con la gravedad de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">El presente estudio respalda la asociaci&#243;n de los niveles altos de eosinofilia en sangre perif&#233;rica y d&#233;rmicos con la gravedad de PA&#46; De igual modo&#44; encontramos una asociaci&#243;n entre las formas diseminadas de la enfermedad y los altos t&#237;tulos de IgG anti-BP180 NC16A&#44; siendo bien conocido que van en paralelo a la actividad de PA&#46; Por contra&#44; encontramos una asociaci&#243;n significativa entre el compromiso mucoso y los niveles m&#225;s bajos de eosin&#243;filos d&#233;rmicos&#44; en concordancia con un estudio reciente que report&#243; una mayor prevalencia de compromiso mucoso en los pacientes con infiltrado inflamatorio pobre en c&#233;lulas<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Observamos que los pacientes con altos niveles de eosin&#243;filos circulantes ten&#237;an un riesgo incrementado de atenci&#243;n hospitalaria y recidiva tras el control exitoso de la enfermedad&#46; Por contra&#44; los niveles de eosin&#243;filos en el infiltrado d&#233;rmico no estuvieron asociados a los resultados del tratamiento&#46; Por tanto&#44; los altos niveles de eosin&#243;filos en sangre perif&#233;rica pueden indicar una presentaci&#243;n cl&#237;nica m&#225;s recalcitrante que precise un manejo m&#225;s agresivo&#46; De forma notable&#44; casi la mitad de los pacientes que experimentaron recidiva ten&#237;an niveles altos o muy altos de eosin&#243;filos circulantes en el momento de la misma&#46; Es m&#225;s&#44; encontramos una correlaci&#243;n fuerte y significativa entre los niveles de eosin&#243;filos circulantes basales y durante la reca&#237;da&#46; Nuestros resultados actuales sugieren que los niveles de eosin&#243;filos circulantes pueden constituir un biomarcador de la recidiva en el PA&#46; Muchos casos de recidiva cl&#237;nica de PA se producen durante los primeros seis meses de seguimiento&#46; Por tanto&#44; la supervisi&#243;n de los niveles de eosin&#243;filos circulantes durante este periodo puede permitir la detecci&#243;n temprana de recidivas&#44; particularmente en los pacientes con altos niveles basales de eosin&#243;filos circulantes&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Nuestro estudio revel&#243; una asociaci&#243;n considerable entre las comorbilidades de los pacientes con PA y los niveles de eosin&#243;filos circulantes y en infiltrados d&#233;rmicos&#46; De manera similar a estudios previos&#44; los pacientes diab&#233;ticos tratados con inhibidores DPP-4 ten&#237;an menores niveles de eosin&#243;filos en sangre perif&#233;rica e infiltrados d&#233;rmicos<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">15&#8211;17</span></a>&#46; Por contra&#44; encontramos que los pacientes con PA y enfermedad neurol&#243;gica ten&#237;an probabilidad de presentar altos niveles de eosin&#243;filos circulantes e infiltrados inflamatorios ricos en eosin&#243;filos&#46; A pesar de haberse reportado previamente la asociaci&#243;n entre las enfermedades neurol&#243;gicas en el PA y los altos niveles de eosin&#243;filos circulantes&#44; su asociaci&#243;n con altos niveles de eosin&#243;filos d&#233;rmicos se ha identificado &#250;nicamente en un estudio recientemente publicado<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8&#44;18</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Se ha sugerido ampliamente la contribuci&#243;n fundamental de los eosin&#243;filos a la patogenia del PA&#44; aument&#225;ndose la creciente evidencia de sus acciones biol&#243;gicas&#46; El incremento de la expresi&#243;n de eotaxina-1 e interleucina &#40;IL&#41;-5&#44; dos mediadores clave en el reclutamiento y activaci&#243;n de eosin&#243;filos&#44; ha sido demostrado en la sangre perif&#233;rica y fluidos ampollosos de los pacientes de PA<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">19&#44;20</span></a>&#46; Tras la activaci&#243;n&#44; en presencia de autoanticuerpos de PA&#44; los eosin&#243;filos contribuyen directamente a la formaci&#243;n de ampollas en el PA&#46; Los eosin&#243;filos desgranulan y liberan prote&#237;nas granulares&#44; tales como la prote&#237;na cati&#243;nica de eosin&#243;filos&#44; las trampas extracelulares de eosin&#243;filos y la metaloproteinasa de la matriz&#44; que contribuyen directamente a la degradaci&#243;n de los ant&#237;genos del PA y la divisi&#243;n de la uni&#243;n d&#233;rmico-epid&#233;rmica<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">10&#44;11</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Los eosin&#243;filos pueden ser un objetivo para las nuevas terapias del PA<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a>&#46; De hecho&#44; el n&#250;mero creciente de tratamientos exitosos del PA con omalizumab respalda esta estrategia<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">22&#44;23</span></a>&#46; Otros f&#225;rmacos emergentes y potenciales para el tratamiento de PA incluyen bertilimumab&#44; un anticuerpo monoclonal totalmente humano que focaliza eotaxina-1&#44; y los anticuerpos monoclonales anti-IL5 tales como mepolizumab y benzalizuma<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">15&#44;24&#44;25</span></a>&#46; La determinaci&#243;n de los niveles de eosin&#243;filos circulantes y d&#233;rmicos puede jugar un papel en t&#233;rminos de selecci&#243;n de pacientes para dichos tratamientos&#46; Aunque son claramente prometedores&#44; son necesarios m&#225;s estudios para evaluar la eficacia y seguridad de las terapias dirigidas a los eosin&#243;filos en el manejo del PA&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La principal limitaci&#243;n del presente estudio es su dise&#241;o retrospectivo&#46; La evaluaci&#243;n de la gravedad de la enfermedad estuvo limitada por la falta de datos sobre el Bullous Penphigoid Disease Area Index &#40;BPDAI&#41;&#46; Adem&#225;s&#44; los niveles tisulares de eosin&#243;filos fueron evaluados en una biopsia de punci&#243;n &#250;nica de la lesi&#243;n&#46; Sin embargo&#44; se obtuvieron biopsias de todos los pacientes procedentes de la lesi&#243;n cut&#225;nea con mayor inflamaci&#243;n&#44; y el recuento fue realizado por tres dermatopat&#243;logos&#46; Podr&#237;a haberse dado una selecci&#243;n de casos m&#225;s graves y recalcitrantes&#44; ya que el estudio fue realizado en un centro de atenci&#243;n terciaria&#46; Sin embargo&#44; nuestro estudio arroja luz sobre una cuesti&#243;n que no ha sido plenamente investigada hasta ahora&#46; Adem&#225;s&#44; aporta una percepci&#243;n nueva sobre la relaci&#243;n entre las caracter&#237;sticas cl&#237;nicas e inmunol&#243;gicas de PA y los niveles de eosin&#243;filos en sangre perif&#233;rica e infiltrados d&#233;rmicos&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; los niveles de eosin&#243;filos circulantes y cut&#225;neos pueden ser biomarcadores &#250;tiles de la actividad de la enfermedad y los resultados del tratamiento del PA&#46; La supervisi&#243;n de los niveles de eosin&#243;filos circulantes y d&#233;rmicos puede permitir la detecci&#243;n temprana de la recidiva&#46; Y&#44; adem&#225;s&#44; la inhibici&#243;n de la actividad de los eosin&#243;filos puede constituir una estrategia&#44; de cara a las nuevas terapias para el PA&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicto de intereses</span><p id="par0140" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El infiltrado inflamatorio d&#233;rmico rico en eosin&#243;filos es una caracter&#237;stica histol&#243;gica destacada de penfigoide ampolloso &#40;PA&#41; y eosinofilia en sangre perif&#233;rica&#44; que se ha documentado en el 50-60&#37; de los pacientes con esta enfermedad&#46; Sin embargo&#44; el impacto de los niveles de eosin&#243;filos circulantes y en infiltrados d&#233;rmicos en el PA sigue sin comprenderse&#46; El objetivo principal de este estudio fue investigar la asociaci&#243;n entre los niveles de eosin&#243;filos en sangre perif&#233;rica y en infiltrados d&#233;rmicos y las caracter&#237;sticas cl&#237;nicas e inmunol&#243;gicas de esta enfermedad&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohorte retrospectivo que incluy&#243; a todos los pacientes con PA entre 2011 y 2020&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El estudio de cohorte incluy&#243; 233 pacientes con PA&#46; El recuento de eosin&#243;filos basal medio en sangre perif&#233;rica fue de 956&#44;3 &#177; 408&#44;6 x10<span class="elsevierStyleSup">6</span>&#47;L y el n&#250;mero medio de eosin&#243;filos tisulares en la zona d&#233;rmica clave fue de 30&#44;5 &#177; 19&#46; Los pacientes con presentaci&#243;n diseminada &#40;es decir&#44; ASC &#62; 50&#37;&#41; tuvieron conteos de eosin&#243;filos en sangre perif&#233;rica significativamente superiores &#40;p &#61; 0&#44;028&#41;&#46; El compromiso mucoso estuvo significativamente asociado a un conteo de eosin&#243;filos cut&#225;neo inferior &#40;p &#61; 0&#44;001&#41;&#46; La necesidad de cuidados hospitalarios y las reca&#237;das estuvieron significativamente asociadas a conteos de eosin&#243;filos en sangre perif&#233;rica m&#225;s elevados &#40;p &#61; 0&#44;025&#59; p &#61; 0&#44;020&#44; respectivamente&#41;&#46; Entre los 68 pacientes que experimentaron recidiva&#44; 31 tuvieron eosinofilia en sangre perif&#233;rica &#40;es decir&#44; &#62; 500 x 10<span class="elsevierStyleSup">6</span>&#47;L&#41; en reca&#237;da &#40;44&#44;2&#37;&#41;&#46; Los conteos de eosin&#243;filos en sangre perif&#233;rica basales y en reca&#237;da se correlacionaron significativamente &#40;r &#61; 0&#44;82&#44; p &#60; 0&#44;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los niveles de eosin&#243;filos en sangre perif&#233;rica y cut&#225;neos pueden constituir biomarcadores &#250;tiles para la actividad de la enfermedad y los resultados terap&#233;uticos en el PA&#46; Supervisar los conteos de eosin&#243;filos en sangre perif&#233;rica puede ayudar a detectar la recidiva tempranamente&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Antecedentes y objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and aims</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A dermal inflammatory infiltrate rich in eosinophils is a prominent histological feature of bullous pemphigoid &#40;BP&#41; and peripheral blood eosinophilia has been documented in 50&#8211;60&#37; of BP patients&#46; Nevertheless&#44; the impact of circulating and dermal infiltrate eosinophil levels on BP remains poorly understood&#46; The main objective of this work was to investigate the association of peripheral blood and dermal infiltrate eosinophil levels with clinical and immunological characteristics of the disease&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective cohort study including all patients diagnosed with BP between 2011 and 2020&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study cohort included 233 patients with BP&#46; The mean baseline peripheral blood eosinophil count was 956&#46;3 &#177; 408&#46;6 &#215; 10<span class="elsevierStyleSup">6</span>&#47;L and the mean number of tissue eosinophils at the dermal hot spot area was 30&#46;5 &#177; 19&#46;0&#46; Patients with disseminated presentation &#40;i&#46;e&#46; BSA &#62; 50&#37;&#41; had significantly higher peripheral blood eosinophil counts &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;028&#41;&#46; Mucosal involvement was significantly associated with lower dermal eosinophil count &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;001&#41;&#46; Requiring inpatient care and relapsing were significantly associated with high peripheral blood eosinophil count &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;025&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;020&#44; respectively&#41;&#46; Among the 68 patients who experienced a relapse&#44; 31 had peripheral blood eosinophilia &#40;i&#46;e&#46; &#62; 500 &#215; 10<span class="elsevierStyleSup">6</span>&#47;L&#41; at relapse &#40;44&#46;2&#37;&#41;&#46; Peripheral blood eosinophil counts at baseline and at relapse were significantly correlated &#40;<span class="elsevierStyleItalic">r</span> &#61; 0&#46;82&#44; <span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Peripheral blood and cutaneous eosinophils levels may be useful biomarkers for disease activity and treatment outcomes in BP&#46; Monitoring peripheral blood eosinophil counts may allow early detection of relapse&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Background and aims"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">PA&#58; penfigoide ampolloso&#59; DPP-4&#58; dipeptidil peptidasa-4&#59; ELISA&#58; ensayo por inmunoabsorci&#243;n ligado a enzimas&#59; n&#58; n&#250;mero&#59; DE&#58; desviaci&#243;n est&#225;ndar&#59; BSA&#58; <span class="elsevierStyleItalic">body surface area</span>&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleBold">Caracter&#237;sticas descriptivas</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Edad durante el diagn&#243;stico&#44; a&#241;os</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Var&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">123 &#40;52&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus tipo 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">113 &#40;48&#44;5&#37;&#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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Enfermedad neurol&#243;gica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93 &#40;39&#44;9&#37;&#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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Neoplasia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;14&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">PA asociado a</span><span class="elsevierStyleItalic">inhibidor de DPP-4&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Vildagliptina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;15&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Linagliptina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;9&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sitagliptina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">12 &#40;5&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">PA asociado a anti-PD-1&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Distribuci&#243;n de las lesiones ampollosas&#59; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Miembros superiores&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">205 &#40;88&#37;&#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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Miembros inferiores&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">202 &#40;86&#44;7&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tronco&nbsp;\t\t\t\t\t\t\n
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                  \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">199 &#40;85&#44;4&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Manos y pies&nbsp;\t\t\t\t\t\t\n
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                  \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">169 &#40;72&#44;5&#37;&#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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Cabeza y cuello&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">57 &#40;24&#44;5&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Compromiso mucoso&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">39 &#40;16&#44;7&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Presentaci&#243;n diseminada &#40;es decir&#44; ASC &#62; 50&#37;&#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">113 &#40;48&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nivel</span><span class="elsevierStyleItalic">de eosin&#243;filos circulantes&#44; basal &#40;&#215;10</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">6</span></span><span class="elsevierStyleItalic">&#47;L&#41;</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Media &#40;DE&#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">956&#44;3 &#40;408&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nivel</span><span class="elsevierStyleItalic">de eosin&#243;filos circulantes&#44; basal&#59; n &#40;&#37;&#41;</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Normal &#40;&#60; 500 &#215; 10<span class="elsevierStyleSup">6</span>&#47;L&#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">96 &#40;41&#44;2&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Alto &#40;500-1&#46;500 &#215; 10<span class="elsevierStyleSup">6</span>&#47;L&#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">114 &#40;48&#44;9&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Muy alto &#40;&#62; 1&#46;500 &#215; 10<span class="elsevierStyleSup">6</span>&#47;L&#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">23 &#40;9&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nivel de</span><span class="elsevierStyleItalic">eosin&#243;filos en infiltrado d&#233;rmico &#40;n&#176; c&#233;lulas&#47;&#225;rea de puntos calientes&#41;</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Media &#40;DE&#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">30&#44;5 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel de</span><span class="elsevierStyleItalic">eosin&#243;filos en infiltrado d&#233;rmico&#59; n &#40;&#37;&#41;</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ausencia &#40;0&#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">8 &#40;3&#44;4&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bajo &#40;&#60; 25&#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">75 &#40;32&#44;2&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Intermedio &#40;25-50&#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">67 &#40;28&#44;8&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Alto &#40;&#62; 50&#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">83 &#40;35&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ELISA IgG anti-BP180 NC16A</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Valor ELISA&#44; media &#40;DE&#41;&#59; &#40;U&#47;mL&#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">128&#44;4 &#40;85&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ELISA IgG anti-PA230 IgG</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Valor ELISA&#44; media &#40;DE&#41;&#59; &#40;U&#47;mL&#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">32&#44;0 &#40;27&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dep&#243;sitos lineales de inmunorreactivos mediante inmunofluorescencia directa&#44; n &#40;&#37;&#41;</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>C3&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">226 &#40;97&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IgG&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">208 &#40;89&#44;3&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IgA&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 &#40;7&#44;3&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IgM&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 &#40;2&#44;1&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>C3 aislado&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">18 &#40;7&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento&#59; n &#40;&#37;&#41;</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Prednisona oral &#40;&#62; 0&#44;5 mg&#47;kg&#47;d&#237;a&#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">219 &#40;94&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tetraciclina&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">109 &#40;46&#44;8&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Inmunosupresores adyuvantes&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">74 &#40;31&#44;8&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tratamiento t&#243;pico aislado&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 &#40;2&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de l&#237;neas de tratamiento</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Media &#40;DE&#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">1&#44;8 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Atenci&#243;n hospitalaria&#59; n &#40;&#37;&#41;</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">89 &#40;39&#44;2&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Recidiva&#59; n &#40;&#37;&#41;</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">68 &#40;29&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nivel de</span><span class="elsevierStyleItalic">eosin&#243;filos circulantes&#44; recidiva &#40;x 10</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">6</span></span><span class="elsevierStyleItalic">&#47;L&#41;</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Media &#40;DE&#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">949&#44;4 &#40;412&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nivel de</span><span class="elsevierStyleItalic">eosin&#243;filos circulantes&#44; recidiva&#59; n &#40;&#37;&#41;</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Normal &#40;&#60; 500 &#215; 10<span class="elsevierStyleSup">6</span>&#47;L&#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">37 &#40;54&#44;4&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Alto &#40;500-1&#46;500 &#215; 10<span class="elsevierStyleSup">6</span>&#47;L&#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">19 &#40;27&#44;9&#37;&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Muy alto &#40;&#62; 1&#46;500 &#215; 10<span class="elsevierStyleSup">6</span>&#47;L&#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">12 &#40;17&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&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  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nivel de eosin&#243;filos circulantes</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">Valor p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nivel de eosin&#243;filos en infiltrados d&#233;rmicos</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">Valor p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" 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
                  \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">Normal &#40;n &#61; 96&#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">Alto o muy alto &#40;n &#61; 137&#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="" 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
                  \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">Ausencia-bajo &#40;n &#61; 83&#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">Intermedio-alto &#40;n &#61; 150&#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="" 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
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad durante el diagn&#243;stico&#44; a&#241;os</span></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"><span class="elsevierStyleHsp" style=""></span>Media &#40;DE&#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">77&#44;2 &#40;9&#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">79&#44;7 &#40;9&#44;8&#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">0&#44;090&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">78&#44;9 &#40;9&#44;5&#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">79&#44;8 &#40;8&#44;8&#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">0&#44;478&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo&#44; n &#40;&#37;&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Mujer&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">42 &#40;43&#44;8&#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">81 &#40;59&#44;1&#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">0&#44;054&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">42 &#40;50&#44;6&#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">81 &#40;54&#44;0&#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">0&#44;579&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"><span class="elsevierStyleHsp" style=""></span>Var&#243;n&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">54 &#40;56&#44;3&#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">56 &#40;40&#44;9&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">41 &#40;49&#44;4&#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">69 &#40;46&#44;0&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades&#44; n &#40;&#37;&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus tipo 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PA asociado a inhibidor DPP-4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad neurol&#243;gica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neoplasia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Distribuci&#243;n de las lesiones ampollosas&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Miembros superiores&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Miembros inferiores&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tronco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Manos y pies&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cabeza y cuello&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Compromiso mucoso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presentaci&#243;n diseminada &#40;es decir&#44; ASC &#62; 50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ELISA</span><span class="elsevierStyleItalic">IgG anti-BP180 NC16A</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ELISA</span><span class="elsevierStyleItalic">IgG Anti-BP230</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dep&#243;sitos lineales de inmunorreactivos mediante inmunofluorescencia directa&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento&#59; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prednisona oral &#40;&#62; 0&#44;5 mg&#47;kg&#47;d&#237;a&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">133 &#40;97&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">81 &#40;97&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">138 &#40;92&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68 &#40;45&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;675&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inmunosupresor adyuvante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tratamiento t&#243;pico aislado&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Relaci&#243;n entre los niveles de eosin&#243;filos circulantes y en infiltrados d&#233;rmicos y las caracter&#237;sticas demogr&#225;ficas&#44; cl&#237;nicas e inmunol&#243;gicas de los pacientes con PA</p>"
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                    0 => array:2 [
                      "titulo" => "Geographic variations in epidemiology of two autoimmune bullous diseases&#58; pemphigus and bullous pemphigoid"
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                      "titulo" => "Autoimmune bullous dermatoses&#58; a review"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "P&#46; Patr&#237;cio"
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                            2 => "M&#46;M&#46; Gomes"
                            3 => "P&#46; Filipe"
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                        "tituloSerie" => "Ann N Y Acad Sci&#46;"
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                            2 => "A&#46; Sparsa"
                            3 => "P&#46; Bernard"
                            4 => "C&#46; B&#233;dane"
                            5 => "S&#46; Duvert-Lehembre"
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                    0 => array:2 [
                      "doi" => "10.1038/jid.2012.35"
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                        "tituloSerie" => "J Invest Dermatol&#46;"
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                        "volumen" => "132"
                        "paginaInicial" => "1998"
                        "paginaFinal" => "2004"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22418872"
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                            3 => "S&#46;M&#46; Langan"
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