Cases for Diagnosis
Treatment-Resistant Adult Atopic Dermatitis
Dermatitis atópica del adulto de evolución tórpida
Leído
7346
Vecesse ha leído el artículo
2350
Total PDF
4996
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S157821901200025X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.01.011" "estado" => "S300" "fechaPublicacion" => "2011-12-01" "aid" => "434" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2011" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2011;102:821-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3236 "formatos" => array:3 [ "EPUB" => 41 "HTML" => 2573 "PDF" => 622 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731011003097" "issn" => "00017310" "doi" => "10.1016/j.ad.2011.03.024" "estado" => "S300" "fechaPublicacion" => "2011-12-01" "aid" => "434" "copyright" => "Elsevier España, S.L. y AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2011;102:821-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 10494 "formatos" => array:3 [ "EPUB" => 4 "HTML" => 5229 "PDF" => 5261 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso para el diagnóstico</span>" "titulo" => "Dermatitis atópica del adulto de evolución tórpida" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "821" "paginaFinal" => "822" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Treatment-Resistant Adult Atopic Dermatitis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 632 "Ancho" => 950 "Tamanyo" => 94335 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Esteve-Martínez, A. García-Rabasco, J. Miralles, J. de-la-Cuadra-Oyanguren" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Esteve-Martínez" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "García-Rabasco" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Miralles" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "de-la-Cuadra-Oyanguren" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S157821901200025X" "doi" => "10.1016/j.adengl.2012.01.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901200025X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011003097?idApp=UINPBA000044" "url" => "/00017310/0000010200000010/v1_201304241344/S0001731011003097/v1_201304241344/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219012000285" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.01.013" "estado" => "S300" "fechaPublicacion" => "2011-12-01" "aid" => "439" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2011;102:823-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3072 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 2372 "PDF" => 648 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cases for Diagnosis</span>" "titulo" => "Grouped Papules and Plaques on the Lower Limbs" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "823" "paginaFinal" => "824" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápulas y placas agrupadas en extremidades inferiores" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1217 "Ancho" => 915 "Tamanyo" => 118596 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.A. Suárez-Pérez, N. López-Navarro, E. Herrera-Acosta" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J.A." "apellidos" => "Suárez-Pérez" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "López-Navarro" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Herrera-Acosta" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731011003140" "doi" => "10.1016/j.ad.2011.03.027" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011003140?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000285?idApp=UINPBA000044" "url" => "/15782190/0000010200000010/v1_201304241244/S1578219012000285/v1_201304241244/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219012000145" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.01.002" "estado" => "S300" "fechaPublicacion" => "2011-12-01" "aid" => "367" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2011;102:817-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4516 "formatos" => array:3 [ "EPUB" => 47 "HTML" => 3638 "PDF" => 831 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Malignant Transformation of a Nevus of Ito: Description of a Rare Case" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "817" "paginaFinal" => "820" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Transformación maligna de un nevus de Ito: descripción de un caso extraordinario" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1750 "Ancho" => 2335 "Tamanyo" => 664586 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The grayish pigmented macule showed a proliferation of typical dendritic melanocytes diffusely spread through a stroma of thick collagen bundles.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Martínez-Peñuela, M.E. Iglesias, M.R. Mercado, J.M. Martínez-Peñuela" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Martínez-Peñuela" ] 1 => array:2 [ "nombre" => "M.E." "apellidos" => "Iglesias" ] 2 => array:2 [ "nombre" => "M.R." "apellidos" => "Mercado" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Martínez-Peñuela" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731011001335" "doi" => "10.1016/j.ad.2011.02.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011001335?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000145?idApp=UINPBA000044" "url" => "/15782190/0000010200000010/v1_201304241244/S1578219012000145/v1_201304241244/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cases for Diagnosis</span>" "titulo" => "Treatment-Resistant Adult Atopic Dermatitis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "821" "paginaFinal" => "822" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Esteve-Martínez, A. García-Rabasco, J. Miralles, J. de-la-Cuadra-Oyanguren" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Esteve-Martínez" "email" => array:1 [ 0 => "aemder@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "García-Rabasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Miralles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "de-la-Cuadra-Oyanguren" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Clínico San Juan de Alicante, Alicante, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis atópica del adulto de evolución tórpida" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 462 "Ancho" => 697 "Tamanyo" => 61473 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 42-year-old woman was referred to our department for the completion of a study on treatment-resistant adult atopic eczema.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The symptoms, which had appeared 5 years earlier, affected the back of both hands and the skin around the mouth and the eyelids. Despite sequential treatment with oral corticosteroids and antihistamines, ciclosporin, and methotrexate combined with systemic corticosteroids, the symptoms worsened.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient had been working as a chef for 8 years. She reported partial improvement of lesions during holiday periods and worsening on return to work. She also had oral allergy syndrome symptoms triggered by certain foods.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0020" class="elsevierStylePara elsevierViewall">Physical examination revealed pruritic, lichenified, erythematous-eczematous plaques on the face, the neck, the back of the hands, the forearms, and the cleavage area (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0025" class="elsevierStylePara elsevierViewall">Total immunoglobulin (Ig) E was 11.198 IU/mL and there was elevated specific IgE against latex and various airborne allergens and foods.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patch tests performed with the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) were all negative.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Prick-to-prick tests conducted with food brought in by the patient that she said caused her to itch were positive for baby squid, cuttlefish, whiting, tomato, wheat flour, and egg yolk (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What is your diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Protein contact dermatitis.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0050" class="elsevierStylePara elsevierViewall">The patient left her job and avoided contact with all foods to which she was sensitized at home. The only treatment administered was tacrolimus ointment 0.1%. At the follow-up visit 8 weeks later, the patient was free of lesions for the first time in 5 years.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0055" class="elsevierStylePara elsevierViewall">Protein contact dermatitis, which was first described in 1976 by Hjorth and Roed-Petersen, is an immediate contact reaction caused by sensitization to high-molecular-weight proteins mostly found in food.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Clinically, it is characterized by pruritus and acute eczematous lesions that appear 10 to 30 minutes after contact with the allergen. If exposure continues, the patient develops typical symptoms of subacute chronic dermatitis, with symptoms worsening with each exposure.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Protein contact dermatitis mainly affects the hands, the forearms, or both. Diffuse eczema of the volar surfaces is the most common clinical manifestation. There have also been reports of localized pulpitis and chronic paronychia.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Eczema may also affect the face, as occurred in our patient, in the case of airborne allergens or when there is indirect contact via the hands.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Some patients, like ours, may report symptoms of oral allergy syndrome following the ingestion of a food to which they are sensitized, but there have been no reports of digestive allergy symptoms, generalized urticaria, or anaphylaxis.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Protein contact dermatitis is primarily an occupational skin disease, and has been described in chefs, slaughterhouse workers, veterinarians, and food handlers in general; it has, however, also been described in amateur anglers who use worms as bait.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">According to the literature, there is an association between protein contact dermatitis and atopic disease in up to 50% of patients. There have also been reports of an association with pre-existing dermatitis. It seems clear that impaired skin barrier function has an important role in the development of protein contact dermatitis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The pathophysiology of the disease remains uncertain. It is an immediate, IgE-mediated contact dermatitis, and in this respect, is similar to immunologic contact urticaria, although the clinical manifestations differ.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Skin tests are the main diagnostic tool.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> The tests of choice are prick-to-prick tests with fresh food, which may be brought in by the patient. Other options are scratch and rub tests, but these only give positive results if performed on affected or previously affected skin; this is one of the characteristics that distinguishes protein contact dermatitis from contact urticaria. Elevated specific IgE levels in serum can also point to a diagnosis of protein contact dermatitis. Patch tests tend to be either negative or irrelevant.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The differential diagnosis should include causes of chronic eczema of the hands—whether of irritant, allergic, or endogenous etiology—and, as occurred in our case, adult atopic dermatitis.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In conclusion, protein contact dermatitis should be suspected in any food handler who develops chronic eczema of the hands, the forearms, or the face. Diagnosis hinges on taking a careful history and performing skin allergy tests. Avoidance of contact with offending allergens can help to achieve complete healing.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Esteve-Martínez A, et al. Dermatitis atópica del adulto de evolución tórpida. Actas Dermosifiliogr.2011;102:821-822.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 493 "Ancho" => 740 "Tamanyo" => 58713 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 462 "Ancho" => 697 "Tamanyo" => 61473 ] ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 763 "Ancho" => 572 "Tamanyo" => 66027 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occupational contact urticaria and protein contact dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Doutre" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J dermatol" "fecha" => "2005" "volumen" => "15" "paginaInicial" => "419" "paginaFinal" => "424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16280292" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatitis de contacto proteicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. De la Cuadra Oyanguren" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2003" "volumen" => "18" "paginaInicial" => "118" "paginaFinal" => "126" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatitis de contacto por alimentos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Amado" 1 => "S.E. Jacob" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2007" "volumen" => "98" "paginaInicial" => "452" "paginaFinal" => "458" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17669298" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immediate contact skin reactions: an update on contact urticaria, contact urticaria syndrom and protein contact dermatitis-“a never ending history”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Gimenez–Arnau" 1 => "M. Maurer" 2 => "J. De la Cuadra" 3 => "M. Maibach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1684/ejd.2010.1049" "Revista" => array:7 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2010" "volumen" => "20" "paginaInicial" => "552" "paginaFinal" => "562" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20732848" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0161642009012822" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La técnica del <span class="elsevierStyleItalic">prick</span> test en la consulta de dermatología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Rodriguez-Serna" 1 => "J. De la Cuadra Oyanguren" 2 => "L. Conde Salazar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2004" "volumen" => "19" "paginaInicial" => "276" "paginaFinal" => "280" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immunological occupational contact urticaria and contact dermatitis from proteins: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Amaro" 1 => "Goossens A" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0536.2007.01267.x" "Revista" => array:6 [ "tituloSerie" => "Contact dermatitis" "fecha" => "2008" "volumen" => "58" "paginaInicial" => "67" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18186738" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010200000010/v1_201304241244/S157821901200025X/v1_201304241244/en/main.assets" "Apartado" => array:4 [ "identificador" => "6171" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010200000010/v1_201304241244/S157821901200025X/v1_201304241244/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901200025X?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 9 | 15 |
| 2024 Octubre | 71 | 48 | 119 |
| 2024 Septiembre | 62 | 31 | 93 |
| 2024 Agosto | 82 | 53 | 135 |
| 2024 Julio | 83 | 47 | 130 |
| 2024 Junio | 74 | 25 | 99 |
| 2024 Mayo | 63 | 33 | 96 |
| 2024 Abril | 80 | 28 | 108 |
| 2024 Marzo | 65 | 27 | 92 |
| 2024 Febrero | 61 | 24 | 85 |
| 2024 Enero | 59 | 38 | 97 |
| 2023 Diciembre | 64 | 25 | 89 |
| 2023 Noviembre | 50 | 18 | 68 |
| 2023 Octubre | 62 | 28 | 90 |
| 2023 Septiembre | 48 | 25 | 73 |
| 2023 Agosto | 39 | 11 | 50 |
| 2023 Julio | 41 | 27 | 68 |
| 2023 Junio | 50 | 20 | 70 |
| 2023 Mayo | 64 | 21 | 85 |
| 2023 Abril | 47 | 15 | 62 |
| 2023 Marzo | 53 | 22 | 75 |
| 2023 Febrero | 46 | 19 | 65 |
| 2023 Enero | 41 | 25 | 66 |
| 2022 Diciembre | 56 | 43 | 99 |
| 2022 Noviembre | 21 | 26 | 47 |
| 2022 Octubre | 20 | 30 | 50 |
| 2022 Septiembre | 15 | 61 | 76 |
| 2022 Agosto | 24 | 29 | 53 |
| 2022 Julio | 22 | 23 | 45 |
| 2022 Junio | 29 | 23 | 52 |
| 2022 Mayo | 41 | 38 | 79 |
| 2022 Abril | 43 | 31 | 74 |
| 2022 Marzo | 48 | 54 | 102 |
| 2022 Febrero | 35 | 31 | 66 |
| 2022 Enero | 30 | 37 | 67 |
| 2021 Diciembre | 29 | 44 | 73 |
| 2021 Noviembre | 31 | 39 | 70 |
| 2021 Octubre | 40 | 51 | 91 |
| 2021 Septiembre | 32 | 36 | 68 |
| 2021 Agosto | 22 | 47 | 69 |
| 2021 Julio | 18 | 30 | 48 |
| 2021 Junio | 29 | 45 | 74 |
| 2021 Mayo | 29 | 47 | 76 |
| 2021 Abril | 68 | 41 | 109 |
| 2021 Marzo | 62 | 38 | 100 |
| 2021 Febrero | 47 | 30 | 77 |
| 2021 Enero | 44 | 26 | 70 |
| 2020 Diciembre | 32 | 27 | 59 |
| 2020 Noviembre | 27 | 20 | 47 |
| 2020 Octubre | 33 | 16 | 49 |
| 2020 Septiembre | 39 | 17 | 56 |
| 2020 Agosto | 19 | 19 | 38 |
| 2020 Julio | 31 | 18 | 49 |
| 2020 Junio | 19 | 32 | 51 |
| 2020 Mayo | 20 | 23 | 43 |
| 2020 Abril | 33 | 14 | 47 |
| 2020 Marzo | 20 | 23 | 43 |
| 2020 Febrero | 5 | 0 | 5 |
| 2020 Enero | 4 | 3 | 7 |
| 2019 Diciembre | 8 | 1 | 9 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 8 | 1 | 9 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 2 | 0 | 2 |
| 2019 Junio | 6 | 11 | 17 |
| 2019 Mayo | 1 | 24 | 25 |
| 2019 Abril | 0 | 11 | 11 |
| 2019 Marzo | 2 | 11 | 13 |
| 2019 Febrero | 0 | 1 | 1 |
| 2019 Enero | 1 | 1 | 2 |
| 2018 Diciembre | 4 | 1 | 5 |
| 2018 Noviembre | 0 | 5 | 5 |
| 2018 Octubre | 5 | 0 | 5 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Febrero | 40 | 1 | 41 |
| 2018 Enero | 52 | 5 | 57 |
| 2017 Diciembre | 49 | 4 | 53 |
| 2017 Noviembre | 54 | 3 | 57 |
| 2017 Octubre | 38 | 9 | 47 |
| 2017 Septiembre | 56 | 9 | 65 |
| 2017 Agosto | 105 | 4 | 109 |
| 2017 Julio | 77 | 6 | 83 |
| 2017 Junio | 95 | 8 | 103 |
| 2017 Mayo | 79 | 3 | 82 |
| 2017 Abril | 72 | 13 | 85 |
| 2017 Marzo | 54 | 12 | 66 |
| 2017 Febrero | 38 | 7 | 45 |
| 2017 Enero | 23 | 8 | 31 |
| 2016 Diciembre | 48 | 7 | 55 |
| 2016 Noviembre | 56 | 8 | 64 |
| 2016 Octubre | 69 | 6 | 75 |
| 2016 Septiembre | 50 | 2 | 52 |
| 2016 Agosto | 59 | 9 | 68 |
| 2016 Julio | 58 | 6 | 64 |
| 2016 Junio | 8 | 1 | 9 |
| 2016 Mayo | 6 | 5 | 11 |
| 2016 Abril | 4 | 1 | 5 |
| 2016 Marzo | 8 | 1 | 9 |
| 2016 Febrero | 6 | 2 | 8 |
| 2016 Enero | 9 | 2 | 11 |
| 2015 Diciembre | 8 | 3 | 11 |
| 2015 Noviembre | 12 | 1 | 13 |
| 2015 Octubre | 10 | 3 | 13 |
| 2015 Septiembre | 5 | 1 | 6 |
| 2015 Agosto | 14 | 4 | 18 |
| 2015 Julio | 49 | 3 | 52 |
| 2015 Junio | 45 | 9 | 54 |
| 2015 Mayo | 65 | 23 | 88 |
| 2015 Abril | 45 | 11 | 56 |
| 2015 Marzo | 36 | 9 | 45 |
| 2015 Febrero | 34 | 5 | 39 |
| 2015 Enero | 31 | 16 | 47 |
| 2014 Diciembre | 45 | 22 | 67 |
| 2014 Noviembre | 30 | 14 | 44 |
| 2014 Octubre | 44 | 11 | 55 |
| 2014 Septiembre | 43 | 8 | 51 |
| 2014 Agosto | 49 | 15 | 64 |
| 2014 Julio | 59 | 24 | 83 |
| 2014 Junio | 62 | 17 | 79 |
| 2014 Mayo | 70 | 12 | 82 |
| 2014 Abril | 67 | 7 | 74 |
| 2014 Marzo | 65 | 15 | 80 |
| 2014 Febrero | 55 | 9 | 64 |
| 2014 Enero | 60 | 16 | 76 |
| 2013 Diciembre | 60 | 20 | 80 |
| 2013 Noviembre | 21 | 4 | 25 |
| 2013 Octubre | 18 | 2 | 20 |
| 2013 Septiembre | 40 | 9 | 49 |
| 2013 Agosto | 15 | 9 | 24 |
| 2013 Julio | 9 | 18 | 27 |
| 2013 Junio | 7 | 16 | 23 |
| 2013 Mayo | 18 | 15 | 33 |
| 2013 Abril | 9 | 20 | 29 |
| 2013 Marzo | 18 | 16 | 34 |
| 2013 Febrero | 33 | 7 | 40 |
| 2013 Enero | 32 | 6 | 38 |
| 2012 Diciembre | 18 | 5 | 23 |
| 2012 Noviembre | 3 | 2 | 5 |
| 2012 Octubre | 1 | 1 | 2 |
| 2012 Julio | 1 | 0 | 1 |
Mostrar todo
