Cases and Research Letters
Exacerbation of Atopic Dermatitis in a Patient Treated With Infliximab
Exacerbación de dermatitis atópica en paciente tratado con infliximab
R. Ruiz-Villaverde
, M. Galán-Gutierrez
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Unidad de Dermatología, Complejo Hospitalario de Jaén, Jaén, Spain
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Ruiz-Villaverde, M. Galán-Gutierrez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" "email" => array:1 [ 0 => "ismenios@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Galán-Gutierrez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Dermatología, Complejo Hospitalario de Jaén, Jaén, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Exacerbación de dermatitis atópica en paciente tratado con infliximab" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 974 "Ancho" => 1301 "Tamanyo" => 182262 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical improvement of our patient after 3 weeks of treatment with oral corticosteroids.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Biologic agents are now being used to treat chronic inflammatory diseases, mainly those of rheumatic, dermatologic, or gastrointestinal origin. This development has led to a reassessment of the diagnosis and therapeutic management of their associated adverse effects, which can include relapses of certain pre-existing diseases that a patient may have; although these relapses have been successfully treated in some cases, they have been difficult to control in others.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We present the case of a patient with infliximab-treated ulcerative colitis who developed a relapse of atopic dermatitis, and we review the cases reported in the literature.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 30-year-old man with a past history of ulcerative colitis on treatment with infliximab; the disease had been refractory to treatment with mesalazine and azathioprine. After the fifth infusion he developed widespread, intensely pruritic eczema that did not respond to topical corticosteroids or oral antihistamines.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient had a history of atopic dermatitis (AD) since childhood, but denied rhinitis or extrinsic asthma. The AD lesions had always developed in flexures (cubital and popliteal fossae) and had responded to corticosteroids and topical calcineurin inhibitors, without requiring systemic treatment or phototherapy.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On physical examination, erythema and fine desquamation were observed on the face, trunk, and in the limb flexures; almost 50% of the body surface area was affected (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were no alterations of vital signs and respiratory function was not affected.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Additional tests did not reveal eosinophilia or elevation of immunoglobulin (Ig) E or acute phase reactants (C-reactive protein, erythrocyte sedimentation rate). Moderate spongiosis and a predominantly lymphocytic perivascular infiltrate were observed on histology. The absence of necrotic keratinocytes, the minimal damage to the basal layer, and the deep lymphocytic infiltrate with no eosinophils, together with the clinical manifestations, were more suggestive of a relapse of his AD than of a toxic dermatitis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">As a precaution it was decided to interrupt treatment with infliximab and start prednisone 0.5<span class="elsevierStyleHsp" style=""></span>mg/kg/d in a slowly tapering regimen. Control of the skin condition was achieved in 3 weeks (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The etiology and pathogenesis of AD is characterized by an acute phase with an inflammatory pattern involving type 2 helper T (T<span class="elsevierStyleInf">H</span>2) cells (often with elevated IgE levels and eosinophil counts), and a chronic phase with a T<span class="elsevierStyleInf">H</span>1 inflammatory pattern. It is therefore to be expected that the anti-tumor necrosis factor (TNF) agents used in psoriasis would improve the chronic forms of AD but that there would be no clear response in the acute phase.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In the chronic phase of AD there is elevation of serum TNF-α, which is released initially by mast cells and subsequently by the T<span class="elsevierStyleInf">H</span> lymphocytes and keratinocytes. The release of the cytokine further stimulates the inflammatory cascade, leading to higher levels of interleukins 1, 6, and 8, intercellular adhesion molecule 1, and vascular cell adhesion molecule. The clinical and pathological progression of a T<span class="elsevierStyleInf">H</span>2 inflammatory pattern to a T<span class="elsevierStyleInf">H</span>1 pattern could explain the successful response to therapy in some series of atopic patients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, it would appear likely that additional, unidentified etiological and pathogenic factors are involved as, in the majority of reported cases, the response is limited to the induction phase.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In our review of the literature we were interested to find 7 well-documented cases of relapses of AD or AD-like disease precipitated by infliximab.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–7</span></a> It is possible that more have not been reported because some relapses of AD may have been categorized as nonspecific eczema (AD has been considered to be a predictive factor for the appearance of eczema-like conditions in patients with psoriasis who receive infliximab),<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> because it is an underdiagnosed adverse effect, or because few cases have required aggressive treatment.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> The details of the cases we found and the case we report are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Almost all patients in the previously published cases had a history of AD and they only differed in the underlying disease for which infliximab had been prescribed. There is no clear pattern that defines the moment at which these reactions may develop, although all occurred within the first 2 years of treatment in these cases. Our patient required systemic treatment and we believe it is important to highlight that, despite the extent of his AD, the changes in laboratory findings in previous reports did not develop in our patient.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although our understanding of biologic therapies and the etiologic and pathogenic factors of AD increases daily, we are still unable to predict the onset of this type of adverse effect, which is surprising from a pathophysiological point of view. We hope that our presentation of this case will draw attention to the need to take a meticulous dermatology history in patients with AD who are candidates for biologic therapy, particularly in patients with rheumatic diseases or inflammatory bowel disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical Responsibilities</span><p id="par0060" class="elsevierStylePara elsevierViewall">Protection of persons and animals: The authors declare that the procedures followed adhere to the ethical guidelines of the responsible committee on human experimentation and comply with the Declaration of Helsinki of the World Medical Association. Data confidentiality: The authors declare that they have followed their hospital's protocol on the publication of data concerning patients and that all patients included in the study have received sufficient information and have given their written informed consent to participate in the study. Right to privacy and informed consent: The authors obtained informed consent from the patients and/or subjects referred to in this article. This document is held by the corresponding author.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical Responsibilities" ] 1 => 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: Ruiz-Villaverde R, Galán-Gutierrez M. Exacerbación de dermatitis atópica en paciente tratado con infliximab. Actas Dermosifiliogr.2012;103:743-746.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 975 "Ancho" => 1300 "Tamanyo" => 180168 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Relapse of atopic dermatitis. State of the patient after the fifth infusion of infliximab.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 974 "Ancho" => 1301 "Tamanyo" => 182262 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical improvement of our patient after 3 weeks of treatment with oral corticosteroids.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: AD: atopic dermatitis; IFX, infliximab.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Age, y \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Underlying Disease \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">History of Atopy \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Dosage \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Timing of the Relapse of AD \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Management \t\t\t\t\t\t\n \t\t\t\t</td></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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (Wright RC<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>) \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 \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">Male \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">Psoriasis \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">1st infusion \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">IFX continued. AD controlled with topical therapy \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (Wright RC<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>) \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 \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">Female \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">Rheumatoid arthritis \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">+/- \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">Not specified \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">IFX continued. AD controlled with topical therapy \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (Vestergaard C et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>) \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">46 \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">Male \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">Suberythrodermic psoriasis<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>psoriatic arthropathy \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">7th infusion \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">IFX discontinued. AD controlled with ciclosporin \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (Vestergaard C et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>) \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 \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">Male \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">Pustular psoriasis \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">8th infusion \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">IFX discontinued. AD controlled with ciclosporin \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (Chan JL et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>) \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">45 \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">Male \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">Psoriasis \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">2nd infusion \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">IFX continued. AD controlled with topical therapy \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (Chan JL et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \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">Female \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">Rheumatoid arthritis \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">7th infusion \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">IFX continued. AD controlled with topical therapy \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (Chan JL et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>) \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 \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">Male \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">Crohn disease \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">3rd infusion \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">IFX discontinued. AD controlled with topical therapy \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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (Ruiz-Villaverde et al.) \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 \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">Male \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">Ulcerative colitis \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">+ \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<span class="elsevierStyleHsp" style=""></span>mg/kg/d \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">5th infusion \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">IFX discontinued. AD controlled with oral<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>topical corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182316.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patient and Clinical Characteristics and Course of Relapses of Atopic Dermatitis Precipitated by Infliximab.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous adverse events of biological therapy for psoriasis: review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.M. Thielen" 1 => "S. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 13 | 23 |
| 2024 Octubre | 98 | 37 | 135 |
| 2024 Septiembre | 96 | 21 | 117 |
| 2024 Agosto | 137 | 51 | 188 |
| 2024 Julio | 118 | 40 | 158 |
| 2024 Junio | 119 | 32 | 151 |
| 2024 Mayo | 88 | 33 | 121 |
| 2024 Abril | 76 | 37 | 113 |
| 2024 Marzo | 113 | 30 | 143 |
| 2024 Febrero | 79 | 31 | 110 |
| 2024 Enero | 68 | 40 | 108 |
| 2023 Diciembre | 85 | 24 | 109 |
| 2023 Noviembre | 75 | 17 | 92 |
| 2023 Octubre | 79 | 17 | 96 |
| 2023 Septiembre | 95 | 27 | 122 |
| 2023 Agosto | 75 | 22 | 97 |
| 2023 Julio | 92 | 38 | 130 |
| 2023 Junio | 69 | 30 | 99 |
| 2023 Mayo | 80 | 28 | 108 |
| 2023 Abril | 72 | 26 | 98 |
| 2023 Marzo | 72 | 21 | 93 |
| 2023 Febrero | 65 | 22 | 87 |
| 2023 Enero | 48 | 25 | 73 |
| 2022 Diciembre | 66 | 45 | 111 |
| 2022 Noviembre | 40 | 30 | 70 |
| 2022 Octubre | 25 | 18 | 43 |
| 2022 Septiembre | 31 | 45 | 76 |
| 2022 Agosto | 32 | 31 | 63 |
| 2022 Julio | 33 | 37 | 70 |
| 2022 Junio | 23 | 20 | 43 |
| 2022 Mayo | 76 | 27 | 103 |
| 2022 Abril | 104 | 27 | 131 |
| 2022 Marzo | 63 | 47 | 110 |
| 2022 Febrero | 57 | 17 | 74 |
| 2022 Enero | 60 | 36 | 96 |
| 2021 Diciembre | 55 | 41 | 96 |
| 2021 Noviembre | 62 | 43 | 105 |
| 2021 Octubre | 72 | 47 | 119 |
| 2021 Septiembre | 64 | 51 | 115 |
| 2021 Agosto | 66 | 29 | 95 |
| 2021 Julio | 71 | 25 | 96 |
| 2021 Junio | 65 | 22 | 87 |
| 2021 Mayo | 57 | 42 | 99 |
| 2021 Abril | 74 | 55 | 129 |
| 2021 Marzo | 39 | 25 | 64 |
| 2021 Febrero | 57 | 22 | 79 |
| 2021 Enero | 33 | 13 | 46 |
| 2020 Diciembre | 34 | 15 | 49 |
| 2020 Noviembre | 29 | 19 | 48 |
| 2020 Octubre | 20 | 16 | 36 |
| 2020 Septiembre | 42 | 14 | 56 |
| 2020 Agosto | 26 | 20 | 46 |
| 2020 Julio | 33 | 18 | 51 |
| 2020 Junio | 47 | 30 | 77 |
| 2020 Mayo | 35 | 14 | 49 |
| 2020 Abril | 32 | 19 | 51 |
| 2020 Marzo | 30 | 26 | 56 |
| 2020 Febrero | 3 | 8 | 11 |
| 2020 Enero | 4 | 2 | 6 |
| 2019 Diciembre | 6 | 2 | 8 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Agosto | 4 | 5 | 9 |
| 2019 Julio | 4 | 6 | 10 |
| 2019 Junio | 4 | 7 | 11 |
| 2019 Mayo | 4 | 14 | 18 |
| 2019 Abril | 2 | 12 | 14 |
| 2019 Marzo | 2 | 8 | 10 |
| 2019 Febrero | 0 | 5 | 5 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Mayo | 0 | 5 | 5 |
| 2018 Marzo | 4 | 2 | 6 |
| 2018 Febrero | 34 | 4 | 38 |
| 2018 Enero | 45 | 13 | 58 |
| 2017 Diciembre | 47 | 8 | 55 |
| 2017 Noviembre | 41 | 5 | 46 |
| 2017 Octubre | 58 | 3 | 61 |
| 2017 Septiembre | 39 | 9 | 48 |
| 2017 Agosto | 45 | 11 | 56 |
| 2017 Julio | 31 | 6 | 37 |
| 2017 Junio | 50 | 7 | 57 |
| 2017 Mayo | 38 | 12 | 50 |
| 2017 Abril | 38 | 24 | 62 |
| 2017 Marzo | 45 | 27 | 72 |
| 2017 Febrero | 35 | 6 | 41 |
| 2017 Enero | 30 | 13 | 43 |
| 2016 Diciembre | 47 | 8 | 55 |
| 2016 Noviembre | 43 | 19 | 62 |
| 2016 Octubre | 66 | 11 | 77 |
| 2016 Septiembre | 56 | 5 | 61 |
| 2016 Agosto | 40 | 7 | 47 |
| 2016 Julio | 32 | 17 | 49 |
| 2016 Junio | 6 | 0 | 6 |
| 2016 Mayo | 9 | 14 | 23 |
| 2016 Abril | 3 | 1 | 4 |
| 2016 Marzo | 6 | 0 | 6 |
| 2016 Febrero | 13 | 2 | 15 |
| 2016 Enero | 4 | 4 | 8 |
| 2015 Diciembre | 7 | 0 | 7 |
| 2015 Noviembre | 21 | 6 | 27 |
| 2015 Octubre | 10 | 6 | 16 |
| 2015 Septiembre | 16 | 1 | 17 |
| 2015 Agosto | 13 | 2 | 15 |
| 2015 Julio | 60 | 9 | 69 |
| 2015 Junio | 35 | 6 | 41 |
| 2015 Mayo | 83 | 12 | 95 |
| 2015 Abril | 77 | 14 | 91 |
| 2015 Marzo | 43 | 4 | 47 |
| 2015 Febrero | 54 | 13 | 67 |
| 2015 Enero | 69 | 20 | 89 |
| 2014 Diciembre | 59 | 14 | 73 |
| 2014 Noviembre | 42 | 13 | 55 |
| 2014 Octubre | 58 | 23 | 81 |
| 2014 Septiembre | 34 | 7 | 41 |
| 2014 Agosto | 21 | 8 | 29 |
| 2014 Julio | 21 | 6 | 27 |
| 2014 Junio | 33 | 4 | 37 |
| 2014 Mayo | 42 | 8 | 50 |
| 2014 Abril | 32 | 2 | 34 |
| 2014 Marzo | 45 | 11 | 56 |
| 2014 Febrero | 31 | 18 | 49 |
| 2014 Enero | 37 | 14 | 51 |
| 2013 Diciembre | 32 | 8 | 40 |
| 2013 Noviembre | 21 | 15 | 36 |
| 2013 Octubre | 11 | 3 | 14 |
| 2013 Septiembre | 16 | 5 | 21 |
| 2013 Agosto | 14 | 12 | 26 |
| 2013 Julio | 15 | 33 | 48 |
| 2013 Junio | 12 | 23 | 35 |
| 2013 Mayo | 14 | 11 | 25 |
| 2013 Abril | 22 | 15 | 37 |
| 2013 Marzo | 17 | 6 | 23 |
| 2013 Febrero | 41 | 4 | 45 |
| 2013 Enero | 37 | 5 | 42 |
| 2012 Diciembre | 27 | 9 | 36 |
| 2012 Noviembre | 7 | 6 | 13 |
| 2012 Octubre | 1 | 1 | 2 |
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