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Wolf's Isotopic Response: A Series of 9 Cases
Fenómeno isotópico de Wolf: serie de 9 casos
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Estudio prospectivo" ] ] "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" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 813 "Ancho" => 2337 "Tamanyo" => 151732 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Case 6. A, Scalp hemangioma before treatment with propranolol. B, Excellent results after 6 months.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Betlloch-Mas, M.T. Martínez-Miravete, A. Lucas-Costa, A.I. Martin de Lara, J. Selva-Otalaurruchi" "autores" => array:5 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Betlloch-Mas" ] 1 => array:2 [ "nombre" => "M.T." 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Jaka-Moreno, A. López-Pestaña, M. López-Núñez, N. Ormaechea-Pérez, S. Vildosola-Esturo, A. Tuneu-Valls, C. Lobo-Morán" "autores" => array:7 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Jaka-Moreno" "email" => array:1 [ 0 => "ajaka@aedv.es" ] "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" => "López-Pestaña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "López-Núñez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "N." "apellidos" => "Ormaechea-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "S." "apellidos" => "Vildosola-Esturo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "A." "apellidos" => "Tuneu-Valls" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "C." "apellidos" => "Lobo-Morán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Donostia, Donostia-San Sebastián, Gipuzkoa, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anatomía Patológica, Hospital Donostia, Donostia-San Sebastián, Gipuzkoa, 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" => "Fenómeno isotópico de Wolf: serie de 9 casos" ] ] "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" => 997 "Ancho" => 1587 "Tamanyo" => 160516 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Case 9: Erythematous-violaceous papules and plaques on the site of previous varicella scars.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Wolf's isotopic response is defined as the appearance of a new skin disease at site of a previous, already healed, unrelated disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In 1876, Koebner<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> described the isomorphic response in reference to the appearance of lesions of a previously existing skin disease on skin that had been subjected to injury. Then, in 1995,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Wolf coined the term <span class="elsevierStyleItalic">isotopic response</span>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In most cases, the initial dermatosis is herpes zoster, but the condition has also been described following herpes simplex, varicella, and thrombophlebitis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> After the initial skin disease has healed, a wide variety of skin diseases may present on the same site; these are mainly granulomatous and lichenoid reactions, infiltrations by hematologic malignancies, skin tumors, and infections.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of our study was to collect cases of the isotopic response diagnosed in our department and to evaluate their particular clinical characteristics.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a retrospective study of all cases of Wolf's isotopic response diagnosed in the dermatology service of Hospital Donostia, San Sebastian, Spain in the 20 years, from 1990 to 2010. A total of 9 cases were collected and are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, which specifies the age, sex, relevant patient history, initial dermatosis and site, second dermatosis, time elapsed between the 2 dermatoses, and the treatment carried out in each case.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnosis of varicella, herpes zoster, or herpes simplex was clinical in most cases, although some cases were confirmed using the Tzanck test or direct immunofluorescence. A histologic study of the second dermatosis was performed in all cases.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>)</span><p id="par0035" class="elsevierStylePara elsevierViewall">A summary of the results is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The patients were aged between 32 and 79 years and distribution by sex was similar: 4 men and 5 women. The initial dermatosis was a herpes infection in all cases: 7 herpes zoster, 1 varicella, and 1 herpes simplex. In our series, 6 out of the 9 cases (66%) had a prior hematologic malignancy.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The initial dermatosis was treated with systemic antiviral drugs in all cases, as most of the patients had associated immunosuppression.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The second dermatoses appeared after intervals of between 15 days and 7 months after the herpes or varicella had resolved. The second dermatoses were 4 cases of granulomatous dermatitis, 2 cases of lichenoid dermatitis, 2 cases of infiltration by B-cell chronic lymphocytic leukemia, and 1 case of infiltration by systemic non-Hodgkin lymphoma.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Below, we will discuss some of the 9 cases of isotopic response included in our series.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case 2</span><p id="par0055" class="elsevierStylePara elsevierViewall">A 72-year-old man with a history of B-cell chronic lymphocytic leukemia who presented herpes zoster on the right flank, on the T10 dermatome (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A month later he visited our department due to skin lesions at the same site. Histopathology revealed a lymphohistiocytic perivascular and interstitial infiltrate with the morphology of interstitial granulomatous dermatitis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case 3</span><p id="par0060" class="elsevierStylePara elsevierViewall">A 79-year-old woman with a history of chronic lymphocytic leukemia visited our department with a lesion on the right side of the upper lip. The lesion had appeared 15 days after the spontaneous resolution of a herpes simplex lesion on the same site. At the time of the visit, the patient presented a slightly infiltrated erythematous plaque measuring 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm on the right side of the upper lip (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). A Tzanck test and direct immunofluorescence for herpes simplex virus type 1 and 2 were negative. Histopathology revealed a lymphohistiocytic infiltrate in the superficial dermis, with multinucleated giant cells forming loose, poorly-defined granulomas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). The lesion gradually resolved following treatment with topical corticosteroids.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case 7</span><p id="par0065" class="elsevierStylePara elsevierViewall">A 68-year-old woman with no relevant history had previously had herpes zoster in the area of the first branch of the right trigeminal nerve. Seven months later, she visited our department due to the appearance of new lesions in the same area. The patient presented a violaceous plaque in the same area in the right frontal region (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). Histopathology revealed a dense lymphoid infiltrate in the dermis; the infiltrate consisted of small and medium-sized lymphocytes that were positive for CD45 staining and were arranged in follicular groups. Immunohistochemistry was positive for CD20 and Bcl-6 and focally positive for CD10 and Bcl-2; these results were compatible with follicular lymphoma (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>B and 3C).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">A bone-marrow biopsy revealed infiltration by the lymphoma. The patient was treated with CHOP and rituximab. In this case, the cutaneous infiltration was the first sign of the lymphoma and made it possible to diagnose the disease.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case 9</span><p id="par0075" class="elsevierStylePara elsevierViewall">A 33-year-old man diagnosed with B-cell chronic lymphocytic leukemia, who had undergone multiple cycles of chemotherapy that included rituximab, fludarabine, and cyclophosphamide and had achieved complete remission 3 years after diagnosis. Two years later, he was admitted with varicella, which resolved after treatment with intravenous aciclovir. After 1 month, he visited our department with skin lesions in the form of erythematous-violaceous plaques on the site of the varicella scars on the face and scalp (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). A skin biopsy revealed a lymphoid tumoral infiltration with diffuse growth, consisting of medium-to-large cells with prominent nuclei and nucleoli (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>A), and a high proliferation rate in the dermis. The infiltrate corresponded to the patient's lymphatic disease which was positive for CD5 (characteristic marker for B-cell chronic lymphocytic leukemia [<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a> B]), CD79, and Bcl-2 and negative for CD30. A diagnosis of transforming B-cell chronic lymphocytic leukemia was made. The staging study confirmed involvement of the bone marrow and the consequent progression of the disease; treatment was therefore begun with CHOP and rituximab, with partial response, followed by different courses of treatment with alemtuzumab, lenalidomide, bendamustine, mitoxantrone, and rituximab. Because of the progression of the disease, the patient underwent an allogenic bone-marrow transplant from an unrelated donor.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In most cases of isotopic response, the initial dermatosis is herpes zoster,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> although it may be herpes simplex, varicella, or thrombophlebitis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In 2002, Cerroni et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported a case of infiltration by chronic lymphocytic leukemia on the scar of a benign cutaneous lymphadenosis due to <span class="elsevierStyleItalic">Borrelia burgdorferi</span>. As in the literature, in our series, all patients presented herpes zoster as the initial dermatosis, except for 2 patients, who presented herpes simplex and varicella.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The nature of the second dermatosis, however, may vary widely (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The most frequent second dermatoses are granulomatous reactions,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–8</span></a> particularly granuloma annulare,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and lichenoid diseases. Cases of lichen planus on herpes zoster scars may require considering a differential diagnosis with zosteriform lichen planus,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–12</span></a> but the definitive diagnosis is based on the clinical history, which shows prior herpes zoster.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Other second dermatoses described in the literature include comedones<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and acneiform eruptions, tinea, furunculosis, contact dermatitis, nodular solar degeneration, morphea, graft-versus-host disease,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> eosinophilic dermatosis, reactive perforating collagenosis, lymphomas and leukemias, Kaposi sarcoma,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> angiosarcoma,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> basal cell carcinomas and squamous cell carcinomas, and skin metastases. Viral infections such as molluscum contagiosum or common warts may also appear on the site of the previous herpes infection. Cases have also been described of centrifugal annular erythema,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> unilateral nevoid telagiectasia,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and psoriasis plaques<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> on the site of herpes zoster scars in patients with no personal or family history of the second disease.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In 1998, Requena et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> published a review of 20 cases; 14 of these developed a granulomatous dermatosis and 4 developed granuloma annulare. The other cases were pseudolymphoma, lichen sclerosus, lichen planus, keloid, and cutaneous Rosai-Dorfman disease.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In our series, 4 of the 9 patients (cases 1-4) developed a granulomatous dermatitis; this was the most frequent reaction, as reported in the literature. Lichenoid dermatitis was observed in 2 cases (cases 5 and 6).</p><p id="par0105" class="elsevierStylePara elsevierViewall">Cases 8 and 9 were infiltrations by B-cell chronic lymphocytic leukemia, which the patients had presented previously. Of note is case 7, as the patient had an undiagnosed systemic B-cell lymphoma; the disease was diagnosed after the skin biopsy. In 1996, Cerroni et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> published 42 cases of infiltrations by B-cell chronic lymphocytic leukemia on herpes zoster and herpes simplex scars. In 2000, Paydaş et al<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> described a case of T-cell lymphoma with skin infiltration in the scar of a previous herpes zoster infection.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In our study, 7 of the 9 patients presented an underlying malignancy, which was hematologic in most cases; this probably led to a state of immunosuppression, thereby predisposing the patient to develop herpes zoster. However, in the larger published series,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> this condition does not appear to be representative. In the review by Requena et al., 5 of the 20 patients had known immunosuppression. The immunosuppression associated with this type of malignancy would explain the higher incidence of herpes infections in these patients. We believe that the fact that our department is in a tertiary hospital, in close contact with the hematology department, led to the high incidence of hematologic malignancies in our series.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The pathogenesis of Wolf's Isotopic Response is unknown. It has been suggested that the nerve damage caused by herpes zoster, which can destroy nerve fibers in the dermis, may alter immunity; this would lead to hyperreactivity that would favor inflammatory processes such as granulomatous and/or lichenoid dermatitis, or local immunosuppression that would lead to tumor infiltrations, such as leukemia cutis, or infectious diseases.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It has also been suggested that the nerve damage may cause abnormal angiogenesis, which would lead to vascular tumors (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). Cell damage caused by the herpes virus does not tend to be observed in histology studies of the second disease. However, cases have been described in which viral DNA has been detected using PCR techniques,<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22,23</span></a> and in which glycoproteins<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> of the herpes zoster viral envelope have been detected using in situ hybridization. No signs of active herpes infection were found in the biopsies of any of our cases.</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Researchers have recently speculated on the role of tumor necrosis factor (TNF)-α in the pathogenesis of this disorder.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> TNF-α is implicated in the immune response to herpes zoster and in a wide variety of inflammatory skin diseases, and is involved in forming and maintaining granulomas.</p><p id="par0125" class="elsevierStylePara elsevierViewall">We agree with the reviewed literature<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> that administration of systemic antiviral treatment probably has no effect on the appearance of the isotopic response.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Finally, the inverse of this phenomenon has also been reported and is referred to by some authors as the inverse isotopic response.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> This is a rare condition in which the dermatosis does not involve the skin previously affected by another disease. The second dermatosis tends to be inflammatory and the previous lesion or dermatosis may be highly heterogeneous, ranging from benign neoplasm to viral infection (such as herpes zoster), and may appear on different sites, such as an irradiated area of skin or the site of a previous vaccination.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0135" class="elsevierStylePara elsevierViewall">We present 9 cases of Wolf's isotopic response, in which the most frequent initial dermatoses are herpes zoster and the most frequent second diseases are granulomatous dermatitis and lichenoid dermatitis, as reported in the literature. Three cases of specific infiltration are of note: one of these was used to diagnose a systemic follicular lymphoma and another to diagnose the progression of the patient's B-cell chronic lymphocytic leukemia. We therefore recommend always performing a skin biopsy in this type of lesion.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres96595" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec83753" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres96594" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec83752" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results (Table 1)" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Case 2" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Case 3" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Case 7" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Case 9" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-10-25" "fechaAceptado" => "2012-02-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec83753" "palabras" => array:3 [ 0 => "Wolf's isotopic response" 1 => "isotopic response" 2 => "herpes zoster" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec83752" "palabras" => array:3 [ 0 => "Fenómeno isotópico de Wolf" 1 => "Respuesta isotópica" 2 => "Herpes zóster" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The term Wolf′s <span class="elsevierStyleItalic">isotopic response</span> refers to the appearance of a new skin disease at the site of an already healed, unrelated disease. In most cases, the initial disease is herpes zoster. Different diseases may subsequently develop on the same site. The most common isotopic responses are granulomatous and lichenoid reactions, infiltrations of hematologic diseases, skin tumors, and infections. The pathogenesis of these skin reactions is unknown. It has been suggested that viral infection may alter local skin immunity; this would favor hyperreactivity, leading to inflammatory processes, or local immunosuppression, leading to tumor infiltrations or infections.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective study of 9 patients diagnosed with Wolf's isotopic response in the dermatology department of Hospital Donostia in San Sebastian, Spain. Five patients had B-cell chronic lymphocytic leukemia, 2 had a non-Hodgkin lymphoma, and 1 had ovarian carcinoma.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The initial disease was herpes zoster in 7 cases, and chickenpox and herpes simplex in the other 2 cases. The second disease was granulomatous dermatitis in 4 cases, lichenoid dermatitis in 2 cases, infiltration by B-cell chronic lymphatic leukemia in 2 cases, and infiltration by systemic non-Hodgkin lymphoma in 1 case. In the last case, the skin lesions were the first sign of the lymphoma.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We highlight the need to biopsy these second lesions in order to rule out tumor infiltrations, which were more frequent than expected in our series.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El fenómeno isotópico de Wolf se define como la aparición de una enfermedad cutánea nueva en la misma localización donde previamente ha acontecido otra, ya curada, y con la que no guarda ninguna relación.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En la mayoría de los casos, la primera dermatosis es un herpes zóster (HZ). Posteriormente, en esta localización pueden desarrollarse diversos procesos dermatológicos, fundamentalmente reacciones granulomatosas y liquenoides, infiltraciones específicas de enfermedades hematológicas, tumores cutáneos o infecciones.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La patogenia de estas reacciones cutáneas es desconocida. Se ha sugerido que la infección viral pudiera alterar la inmunidad cutánea local, favoreciendo una hiperreactividad que determinaría el desarrollo de procesos inflamatorios, o una inmunosupresión local, que condicionaría la aparición de infiltraciones tumorales o infecciones.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de 9 pacientes diagnosticados de fenómeno isotópico de Wolf en el Servicio de Dermatología del Hospital Donostia. Cinco pacientes tenían una leucemia linfática crónica-B (LLC-B), 2 un linfoma no Hodgkin y una un carcinoma de ovario.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La dermatosis primaria en 7 casos fue un HZ, en los otros 2 una varicela y un herpes simple. Respecto a las dermatosis secundarias se diagnosticaron 4 casos de dermatitis granulomatosa, 2 de dermatitis liquenoide, 2 de infiltración específica por LLC-B y uno de infiltración por un linfoma no Hodgkin sistémico. En este último caso las lesiones cutáneas fueron el primer signo del linfoma.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Destacamos la necesidad de biopsiar este tipo de lesiones para descartar infiltraciones específicas tumorales, ya que en nuestra casuística fueron más frecuentes de lo esperado.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Jaka-Moreno A, et al. Fenómeno isotópico de Wolf: serie de 9 casos. Actas Dermosifiliogr. 2012;103:798-805.</p>" ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2277 "Ancho" => 1580 "Tamanyo" => 381032 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Case 2: A, Purplish-brown plaques on the right flank, coalescing on the T10 dermatome. B, Case 2 Lymphohistiocytic perivascular and interstitial infiltrate (hematoxylin-eosin, original magnification x10).</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" => 2180 "Ancho" => 1585 "Tamanyo" => 407169 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Case 3: A, Slightly infiltrated erythematous plaque with a corrugated surface, located on the right side of the upper lip. B, Granulomatous infiltrate in the superficial dermis, consisting of histiocytic growth and multinucleated-giant-cell forming loose, poorly-defined granulomas (hematoxylin-eosin, original magnification x10).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 918 "Ancho" => 3002 "Tamanyo" => 433714 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Case 7: A, Erythematous-violaceous tumorous lesion in the right frontal area, in the region of the first branch of the trigeminal nerve. B, Lymphoid tumorous infiltration occupying the superficial and deep dermis and forming large groups with a follicular appearance (hematoxylin-eosin, original magnification x10). C, Small-to-medium-sized atypical lymphocytes arranged in follicular groups (hematoxylin-eosin, original magnification x20).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 997 "Ancho" => 1587 "Tamanyo" => 160516 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Case 9: Erythematous-violaceous papules and plaques on the site of previous varicella scars.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 2750 "Ancho" => 1498 "Tamanyo" => 526159 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Case 9: A, Medium-to-large-sized lymphoid cells with prominent nuclei and nucleoli, presenting mitotic activity (hematoxylin-eosin, original magnification x20). B, Diffuse CD5-positive tumorous infiltrate in the dermis, which corresponds to the skin infiltration by the patient's B-cell chronic lymphocytic leukemia (CD5 marker, original magnification x4).</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 2257 "Ancho" => 3340 "Tamanyo" => 212446 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Pathogenesis algorithm in Wolf's isotopic response.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: B-CLL indicates B-cell chronic lymphocytic leukemia; CHOP, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone; F, female; IV, intravenous; M, male; NHL, non-Hodgkin lymphoma; and R-CHOP, CHOP plus rituximab.</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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Case no.° \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/Age \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 \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">Initial Dermatosis \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">Location \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">Time \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">Second Dermatosis \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">Treatment of Initial Dermatosis \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">Treatment of Second Dermatosis \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 \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">F/63 \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">Ovarian cancer \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">Herpes zoster \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">L2 \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 mo \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">Granulomatous dermatitis \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">Oral valaciclovir \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 corticosteroids \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 \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">M/71 \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">B-CLL \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">Herpes zoster \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">T10 \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 mo \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">Granulomatous dermatitis \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">IV aciclovir \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 corticosteroids \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 \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">F/79 \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">B-CLL \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">Herpes simplex \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">Lip \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 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">Granulomatous dermatitis \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">Oral valaciclovir \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 corticosteroids \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 \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">F/64 \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">Chronic rash \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">Herpes zoster \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">C4 \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 mo \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">Granuloma annulare \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">Oral valaciclovir \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 corticosteroids \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 \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">F/53 \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">NHL \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">Herpes zoster \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">T8 \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 mo \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">Lichenoid dermatitis \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">IV aciclovir \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">None \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 \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">M/54 \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">B-CLL \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">Herpes zoster \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">L2 \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 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">Lichenoid dermatitis \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">IV aciclovir \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">None \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 \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">F/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">No \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">Herpes zoster \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 branch right trigeminal nerve \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">7 mo \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">Systemic lymphoma \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">Oral valaciclovir \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">R-CHOP \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 \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">M/71 \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">B-CLL \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">Herpes zoster \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">T2 \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 mo \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">Leukemia cutis \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">IV aciclovir \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">Polychemotherapy \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">9 \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">M/32 \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">B-CLL \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">Varicella \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">Crown \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 mo \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">Leukemia cutis \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">IV aciclovir \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">R-CHOP \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182576.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the Cases of Wolf's Isotopic Response.</p>" ] ] 7 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Inflammatory 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">Tumoral 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">Infectious 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">Others \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">Granulomatous reactions (granuloma annulare) \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">Specific infiltrations (leukemias and lymphomas) \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">Viral infections (<span class="elsevierStyleItalic">molluscum</span>, common warts) \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">Acneiform eruptions \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">Lichenoid reactions (lichen planus) \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">Pseudolymphoma \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">Tinea \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">Keloid \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">Sclerotic and atrophic lichen \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">Basal cell carcinoma and squamous cell carcinoma \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">Furunculosis \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">Comedones \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">Morphea \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">Skin metastases of solid-organ tumors \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"> \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">Cutaneous Rosai-Dorfman disease \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">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">Kaposi sarcoma \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"> \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">Xanthoma \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">Contact dermatitis \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">Angiosarcoma \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"> \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">Nodular solar degeneration \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">Eosinophilic dermatosis \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"> \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"> \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">Reactive perforating collagenosis \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">Graft-versus-host 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="" 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="" 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">Unilateral nevoid telangiectasia \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">Centrifugal annular erythema \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"> \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"> \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"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182577.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Second Dermatoses in Wolf's Isotopic Response.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 29 | 10 | 39 |
| 2024 Octubre | 177 | 50 | 227 |
| 2024 Septiembre | 232 | 48 | 280 |
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| 2024 Marzo | 117 | 31 | 148 |
| 2024 Febrero | 127 | 40 | 167 |
| 2024 Enero | 98 | 51 | 149 |
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| 2023 Noviembre | 397 | 34 | 431 |
| 2023 Octubre | 124 | 27 | 151 |
| 2023 Septiembre | 113 | 33 | 146 |
| 2023 Agosto | 95 | 20 | 115 |
| 2023 Julio | 75 | 35 | 110 |
| 2023 Junio | 83 | 23 | 106 |
| 2023 Mayo | 104 | 44 | 148 |
| 2023 Abril | 93 | 22 | 115 |
| 2023 Marzo | 88 | 31 | 119 |
| 2023 Febrero | 79 | 27 | 106 |
| 2023 Enero | 61 | 49 | 110 |
| 2022 Diciembre | 71 | 38 | 109 |
| 2022 Noviembre | 55 | 41 | 96 |
| 2022 Octubre | 40 | 34 | 74 |
| 2022 Septiembre | 34 | 54 | 88 |
| 2022 Agosto | 39 | 56 | 95 |
| 2022 Julio | 54 | 42 | 96 |
| 2022 Junio | 39 | 33 | 72 |
| 2022 Mayo | 89 | 42 | 131 |
| 2022 Abril | 171 | 58 | 229 |
| 2022 Marzo | 178 | 64 | 242 |
| 2022 Febrero | 152 | 32 | 184 |
| 2022 Enero | 136 | 54 | 190 |
| 2021 Diciembre | 99 | 42 | 141 |
| 2021 Noviembre | 102 | 66 | 168 |
| 2021 Octubre | 73 | 65 | 138 |
| 2021 Septiembre | 64 | 68 | 132 |
| 2021 Agosto | 91 | 50 | 141 |
| 2021 Julio | 57 | 55 | 112 |
| 2021 Junio | 53 | 55 | 108 |
| 2021 Mayo | 57 | 49 | 106 |
| 2021 Abril | 96 | 69 | 165 |
| 2021 Marzo | 73 | 51 | 124 |
| 2021 Febrero | 68 | 27 | 95 |
| 2021 Enero | 55 | 36 | 91 |
| 2020 Diciembre | 53 | 38 | 91 |
| 2020 Noviembre | 34 | 42 | 76 |
| 2020 Octubre | 53 | 45 | 98 |
| 2020 Septiembre | 30 | 18 | 48 |
| 2020 Agosto | 31 | 16 | 47 |
| 2020 Julio | 48 | 23 | 71 |
| 2020 Junio | 46 | 27 | 73 |
| 2020 Mayo | 17 | 25 | 42 |
| 2020 Abril | 41 | 25 | 66 |
| 2020 Marzo | 87 | 33 | 120 |
| 2020 Febrero | 6 | 9 | 15 |
| 2020 Enero | 4 | 12 | 16 |
| 2019 Diciembre | 8 | 11 | 19 |
| 2019 Noviembre | 4 | 13 | 17 |
| 2019 Octubre | 0 | 9 | 9 |
| 2019 Septiembre | 8 | 9 | 17 |
| 2019 Agosto | 4 | 13 | 17 |
| 2019 Julio | 6 | 26 | 32 |
| 2019 Junio | 6 | 26 | 32 |
| 2019 Mayo | 5 | 28 | 33 |
| 2019 Abril | 2 | 30 | 32 |
| 2019 Marzo | 2 | 9 | 11 |
| 2019 Febrero | 2 | 6 | 8 |
| 2019 Enero | 2 | 2 | 4 |
| 2018 Diciembre | 6 | 8 | 14 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 6 | 3 | 9 |
| 2018 Agosto | 0 | 11 | 11 |
| 2018 Julio | 0 | 9 | 9 |
| 2018 Junio | 0 | 2 | 2 |
| 2018 Mayo | 0 | 3 | 3 |
| 2018 Abril | 0 | 4 | 4 |
| 2018 Marzo | 9 | 9 | 18 |
| 2018 Febrero | 89 | 13 | 102 |
| 2018 Enero | 93 | 19 | 112 |
| 2017 Diciembre | 86 | 6 | 92 |
| 2017 Noviembre | 99 | 9 | 108 |
| 2017 Octubre | 86 | 6 | 92 |
| 2017 Septiembre | 94 | 13 | 107 |
| 2017 Agosto | 124 | 21 | 145 |
| 2017 Julio | 92 | 19 | 111 |
| 2017 Junio | 85 | 25 | 110 |
| 2017 Mayo | 72 | 29 | 101 |
| 2017 Abril | 118 | 26 | 144 |
| 2017 Marzo | 87 | 19 | 106 |
| 2017 Febrero | 149 | 25 | 174 |
| 2017 Enero | 119 | 15 | 134 |
| 2016 Diciembre | 142 | 13 | 155 |
| 2016 Noviembre | 137 | 22 | 159 |
| 2016 Octubre | 172 | 26 | 198 |
| 2016 Septiembre | 262 | 22 | 284 |
| 2016 Agosto | 215 | 19 | 234 |
| 2016 Julio | 108 | 18 | 126 |
| 2016 Junio | 7 | 21 | 28 |
| 2016 Mayo | 8 | 21 | 29 |
| 2016 Abril | 13 | 2 | 15 |
| 2016 Marzo | 14 | 7 | 21 |
| 2016 Febrero | 8 | 1 | 9 |
| 2016 Enero | 8 | 2 | 10 |
| 2015 Diciembre | 9 | 5 | 14 |
| 2015 Noviembre | 33 | 1 | 34 |
| 2015 Octubre | 36 | 4 | 40 |
| 2015 Septiembre | 71 | 2 | 73 |
| 2015 Agosto | 24 | 4 | 28 |
| 2015 Julio | 199 | 12 | 211 |
| 2015 Junio | 146 | 13 | 159 |
| 2015 Mayo | 147 | 29 | 176 |
| 2015 Abril | 146 | 27 | 173 |
| 2015 Marzo | 290 | 13 | 303 |
| 2015 Febrero | 217 | 17 | 234 |
| 2015 Enero | 395 | 13 | 408 |
| 2014 Diciembre | 167 | 18 | 185 |
| 2014 Noviembre | 102 | 13 | 115 |
| 2014 Octubre | 73 | 5 | 78 |
| 2014 Septiembre | 68 | 4 | 72 |
| 2014 Agosto | 52 | 2 | 54 |
| 2014 Julio | 71 | 8 | 79 |
| 2014 Junio | 82 | 4 | 86 |
| 2014 Mayo | 92 | 20 | 112 |
| 2014 Abril | 69 | 7 | 76 |
| 2014 Marzo | 78 | 12 | 90 |
| 2014 Febrero | 59 | 7 | 66 |
| 2014 Enero | 58 | 9 | 67 |
| 2013 Diciembre | 57 | 9 | 66 |
| 2013 Noviembre | 51 | 13 | 64 |
| 2013 Octubre | 61 | 11 | 72 |
| 2013 Septiembre | 41 | 10 | 51 |
| 2013 Agosto | 43 | 10 | 53 |
| 2013 Julio | 12 | 21 | 33 |
| 2013 Junio | 13 | 21 | 34 |
| 2013 Mayo | 14 | 29 | 43 |
| 2013 Abril | 16 | 16 | 32 |
| 2013 Marzo | 15 | 11 | 26 |
| 2013 Febrero | 36 | 8 | 44 |
| 2013 Enero | 69 | 6 | 75 |
| 2012 Diciembre | 21 | 8 | 29 |
| 2012 Noviembre | 7 | 1 | 8 |
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