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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Keratoacanthoma &#40;KA&#41; is a skin tumor that&#44; unlike classic cutaneous squamous cell carcinoma &#40;SCC&#41;&#44; grows rapidly and can subsequently partially or completely resolve&#46; While some evidence supports its classification as a well differentiated variant of SCC&#44; this remains a topic of debate&#46; Clinical differentiation from SCC can be difficult&#44; but it is useful to distinguish one from the other&#44; as there are nonsurgical therapeutic options &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; that may be useful for the treatment of KA&#44; including intralesional infiltration of methotrexate &#40;MTX&#41; or 5-fluorouracil &#40;5-FU&#41;&#44; as well as topical application of imiquimod or 5-FU&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Other&#44; less frequently used intralesional substances&#44; for which less supporting data are available&#44; include bleomycin&#44; corticosteroids&#44; and interferon alfa&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Moss et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> recently published the largest study comparing intralesional MTX with conventional surgery in patients with a clinical or histological diagnosis of KA &#40;n&#8239;&#61;&#8239;136&#59; 157 tumors&#41;&#46; In each case&#44; the treatment decision was reached following consultation between the physician and the patient&#46; In the 54 patients &#40;n&#8239;&#61;&#8239;73&#41; for whom intralesional MTX was indicated&#44; a variable volume of 0&#46;075-1&#8239;mL &#40;depending on tumor size&#41; was injected into the tumor base at a concentration of 12&#46;5&#8239;mg&#47;mL &#40;25&#8239;mg&#47;mL MTX diluted 50&#37; with 1&#37; lidocaine and 1&#58;100 000 adrenaline&#41;&#46; Doses were administered every 2-4 weeks&#46; Complete resolution after 1 to 4 infiltrations &#40;mean&#44; 2&#46;1&#41; was observed in 88&#37; &#40;64 of 73&#41; of KAs&#46; Clinical cure was confirmed between 6 and 8 weeks after the last infiltration&#46; The 9 patients who did not respond to intralesional MTX &#40;8 KA lesions decreased in size and 1 remained unchanged&#41; presented solitary KAs that were treated surgically&#44; without complications&#46; No moderate-to-severe adverse effects were observed in any of the patients treated with intralesional MTX&#46; Mohs micrographic surgery was used for all of the 84 surgically-treated tumors&#44; without recurrences or surgical complications&#46; In an Italian series of 11 elderly patients with KA&#44; mainly affecting the head and hands&#44; weekly intralesional MTX infusions &#40;median&#44; 5&#46;3&#59; range&#44; 4-8&#41; resulted in complete resolution in all cases&#44; without systemic adverse effects or recurrences after 6-9 months of follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A 2019 systematic review of nonsurgically-treated KA &#40;n&#8239;&#61;&#8239;184&#41;&#44; not including the series by Moss et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> found no significant differences in the rate of resolution between topical and intralesional treatments &#40;92&#37; and 100&#37;&#44; respectively&#41;&#44; but reported a faster response for intralesional 5-FU versus intralesional MTX &#40;3&#46;7 vs 4&#46;6 wk&#44; which may not constitute a clinically significant difference&#41; and for topical 5-FU versus topical imiquimod &#40;3&#46;8 vs 7&#46;6 wk&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Similar findings were reported in another recent review&#44; with a 94&#37; cure rate and no adverse effects of note&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Spanish authors evaluated intralesional MTX as neoadjuvant therapy prior to KA surgery&#44; and concluded that it is a well-tolerated measure that precludes the need for aggressive surgeries in facial or acral areas in elderly patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Because spontaneous resolution of KA can take up to 1&#8239;year&#44; or not occur at all&#44; most authors recommend targeted treatment&#46; Nonsurgical techniques &#40;infiltrations and topical treatments&#41; can be valid alternatives for KA located in complex areas &#40;facial or acral&#41; or in elderly patients&#46;</p></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-3 times per day&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">1-8 wk&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">Mild skin irritationAcute pruritus and contact dermatitis&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">Intralesional&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">15&#8239;mg&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 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3-4 wk&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">Discomfort at moment of injectionFocal irritation and necrosisHypopigmentation&#44; purulent exudateErythema&#44; edema&#44; and lymphedema&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">Imiquimod&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">Topical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37; cream&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">1-3 times per week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3-11 wk&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">Erythema and crusting&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</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">Intralesional&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&#46;2-0&#46;4 mg&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 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2-6 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 MUI&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 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">50&#8239;mg HC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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Resident’s Forum
RF - Nonsurgical Treatment of Keratoacanthomas
FR - Tratamiento no quirúrgico de los queratoacantomas
X. Bosch-Amate, C. Mancinelli, D. Morgado-Carrasco
Autor para correspondencia
morgadodaniel8@gmail.com

Corresponding author.
Departamento de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Keratoacanthoma &#40;KA&#41; is a skin tumor that&#44; unlike classic cutaneous squamous cell carcinoma &#40;SCC&#41;&#44; grows rapidly and can subsequently partially or completely resolve&#46; While some evidence supports its classification as a well differentiated variant of SCC&#44; this remains a topic of debate&#46; Clinical differentiation from SCC can be difficult&#44; but it is useful to distinguish one from the other&#44; as there are nonsurgical therapeutic options &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; that may be useful for the treatment of KA&#44; including intralesional infiltration of methotrexate &#40;MTX&#41; or 5-fluorouracil &#40;5-FU&#41;&#44; as well as topical application of imiquimod or 5-FU&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Other&#44; less frequently used intralesional substances&#44; for which less supporting data are available&#44; include bleomycin&#44; corticosteroids&#44; and interferon alfa&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Moss et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> recently published the largest study comparing intralesional MTX with conventional surgery in patients with a clinical or histological diagnosis of KA &#40;n&#8239;&#61;&#8239;136&#59; 157 tumors&#41;&#46; In each case&#44; the treatment decision was reached following consultation between the physician and the patient&#46; In the 54 patients &#40;n&#8239;&#61;&#8239;73&#41; for whom intralesional MTX was indicated&#44; a variable volume of 0&#46;075-1&#8239;mL &#40;depending on tumor size&#41; was injected into the tumor base at a concentration of 12&#46;5&#8239;mg&#47;mL &#40;25&#8239;mg&#47;mL MTX diluted 50&#37; with 1&#37; lidocaine and 1&#58;100 000 adrenaline&#41;&#46; Doses were administered every 2-4 weeks&#46; Complete resolution after 1 to 4 infiltrations &#40;mean&#44; 2&#46;1&#41; was observed in 88&#37; &#40;64 of 73&#41; of KAs&#46; Clinical cure was confirmed between 6 and 8 weeks after the last infiltration&#46; The 9 patients who did not respond to intralesional MTX &#40;8 KA lesions decreased in size and 1 remained unchanged&#41; presented solitary KAs that were treated surgically&#44; without complications&#46; No moderate-to-severe adverse effects were observed in any of the patients treated with intralesional MTX&#46; Mohs micrographic surgery was used for all of the 84 surgically-treated tumors&#44; without recurrences or surgical complications&#46; In an Italian series of 11 elderly patients with KA&#44; mainly affecting the head and hands&#44; weekly intralesional MTX infusions &#40;median&#44; 5&#46;3&#59; range&#44; 4-8&#41; resulted in complete resolution in all cases&#44; without systemic adverse effects or recurrences after 6-9 months of follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A 2019 systematic review of nonsurgically-treated KA &#40;n&#8239;&#61;&#8239;184&#41;&#44; not including the series by Moss et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> found no significant differences in the rate of resolution between topical and intralesional treatments &#40;92&#37; and 100&#37;&#44; respectively&#41;&#44; but reported a faster response for intralesional 5-FU versus intralesional MTX &#40;3&#46;7 vs 4&#46;6 wk&#44; which may not constitute a clinically significant difference&#41; and for topical 5-FU versus topical imiquimod &#40;3&#46;8 vs 7&#46;6 wk&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Similar findings were reported in another recent review&#44; with a 94&#37; cure rate and no adverse effects of note&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Spanish authors evaluated intralesional MTX as neoadjuvant therapy prior to KA surgery&#44; and concluded that it is a well-tolerated measure that precludes the need for aggressive surgeries in facial or acral areas in elderly patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Because spontaneous resolution of KA can take up to 1&#8239;year&#44; or not occur at all&#44; most authors recommend targeted treatment&#46; Nonsurgical techniques &#40;infiltrations and topical treatments&#41; can be valid alternatives for KA located in complex areas &#40;facial or acral&#41; or in elderly patients&#46;</p></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; HC&#44; hydrocortisone&#59; MUI&#44; million international units&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Drug&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Route of administration&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Interval&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t">Methotrexate&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">Intralesional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#46;5&#8239;mg&#47;mL &#40;0&#46;075-1&#8239;mL&#41;&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">1-4 weeks&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">1-4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Moderate pain at moment of injectionPancytopenia<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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  " align="left" valign="\n
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                  \t\t\t\t">Topical&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">5&#37; ointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1-3 times per day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1-8 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Mild skin irritationAcute pruritus and contact dermatitis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 wk&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Discomfort at moment of injectionFocal irritation and necrosisHypopigmentation&#44; purulent exudateErythema&#44; edema&#44; and lymphedema&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Imiquimod&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">Topical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37; cream&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">1-3 times per week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3-11 wk&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">Erythema and crusting&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">Bleomycin<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&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">Intralesional&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&#46;2-0&#46;4 mg&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 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2-6 wk&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">Erythema&#44; pigmentation&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">Interferon alfa<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&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">Intralesional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 MUI&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 wk&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">5-7 wk&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">Local painNeutropeniaUrticariaFlu-like symptoms&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">Corticosteroids<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&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">Intralesional&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">50&#8239;mg HC&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 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 wk&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">Hypopigmentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">We always recommend histological confirmation before indicating nonsurgical treatment&#44; as it can be difficult to clinically differentiate keratoacanthoma from cutaneous squamous cell carcinoma&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Despite the fact that no moderate or serious adverse effects have been recorded in the majority of patients&#44; pancytopenia after treatment with intralesional methotrexate has been described in 2 patients with chronic kidney disease&#46; It is therefore recommended to perform laboratory tests before and after drug infiltration&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nonsurgical Alternatives for the Management of Keratoacanthoma&#46;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>"
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                        0 => array:2 [
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                          "autores" => array:4 [
                            0 => "E&#46;W&#46; Seger"
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                      "doi" => "10.1177/1203475419882336"
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                        "tituloSerie" => "J Cutan Med Surg"
                        "fecha" => "2020"
                        "volumen" => "24"
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                        "paginaFinal" => "46"
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                    0 => array:2 [
                      "titulo" => "Ensayo cl&#237;nico&#58; la infiltraci&#243;n intralesional con metotrexato de forma neoadyuvante en la cirug&#237;a del queratoacantoma permite obtener mejores resultados est&#233;ticos y funcionales"
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                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr"
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                      "titulo" => "Intralesional therapy for the treatment of keratoacanthoma"
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                    0 => array:2 [
                      "doi" => "10.1111/dth.12872"
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                        "tituloSerie" => "Dermatol Ther"
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                        "volumen" => "32"
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