Case and research letter
Successful Treatment of Recalcitrant Chronic Foot Eczema with Alitertinoin
Tratamiento exitoso de un ezcema crónico recalcitrante de las plantas con alitretinoína
A. Tejera-Vaquerizo
, J.S. Sánchez-Vizcaíno, V. Haro-Gabaldón
Autor para correspondencia
Servicio de Dermatología, Hospital Infanta Margarita, Cabra-Córdoba, Spain
Leído
20423
Vecesse ha leído el artículo
3506
Total PDF
16917
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219012003162" "issn" => "15782190" "doi" => "10.1016/j.adengl.2011.12.005" "estado" => "S300" "fechaPublicacion" => "2012-12-01" "aid" => "640" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2011" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2012;103:931-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4366 "formatos" => array:3 [ "EPUB" => 47 "HTML" => 3181 "PDF" => 1138 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731012002244" "issn" => "00017310" "doi" => "10.1016/j.ad.2011.12.023" "estado" => "S300" "fechaPublicacion" => "2012-12-01" "aid" => "640" "copyright" => "Elsevier España, S.L. y AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2012;103:931-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6986 "formatos" => array:3 [ "EPUB" => 6 "HTML" => 5043 "PDF" => 1937 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Tratamiento exitoso de un ezcema crónico recalcitrante de las plantas con alitretinoína" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "931" "paginaFinal" => "932" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Successful Treatment of Recalcitrant Chronic Foot Eczema with Alitretinoin" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2385 "Ancho" => 1583 "Tamanyo" => 341108 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Aspecto del eczema en las plantas. B. Vista lateral.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Tejera-Vaquerizo, J.S. Sánchez-Vizcaíno, V. Haro-Gabaldón" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Tejera-Vaquerizo" ] 1 => array:2 [ "nombre" => "J.S." "apellidos" => "Sánchez-Vizcaíno" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Haro-Gabaldón" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219012003162" "doi" => "10.1016/j.adengl.2011.12.005" "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/S1578219012003162?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012002244?idApp=UINPBA000044" "url" => "/00017310/0000010300000010/v1_201304241557/S0001731012002244/v1_201304241557/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219012003174" "issn" => "15782190" "doi" => "10.1016/j.adengl.2011.12.006" "estado" => "S300" "fechaPublicacion" => "2012-12-01" "aid" => "638" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2012;103:932-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 20624 "formatos" => array:3 [ "EPUB" => 73 "HTML" => 18052 "PDF" => 2499 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and research letter</span>" "titulo" => "Dermatosis Neglecta or Terra Firma-Forme Dermatosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "932" "paginaFinal" => "934" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatosis neglecta o <span class="elsevierStyleItalic">terra firma-forme dermatosis</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1197 "Ancho" => 1585 "Tamanyo" => 143823 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical appearance of the lesions.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Martín-Gorgojo, V. Alonso-Usero, M. Gavrilova, E. Jordá-Cuevas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Martín-Gorgojo" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Alonso-Usero" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Gavrilova" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Jordá-Cuevas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012002220" "doi" => "10.1016/j.ad.2011.12.022" "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/S0001731012002220?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012003174?idApp=UINPBA000044" "url" => "/15782190/0000010300000010/v1_201304241352/S1578219012003174/v1_201304241352/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219012003150" "issn" => "15782190" "doi" => "10.1016/j.adengl.2011.12.004" "estado" => "S300" "fechaPublicacion" => "2012-12-01" "aid" => "647" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2012;103:929-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5435 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 4556 "PDF" => 827 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and research letter</span>" "titulo" => "Periorificial Cutaneous Tuberculosis of the Vulva" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "929" "paginaFinal" => "930" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tuberculosis cutánea periorificial vulvar" ] ] "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" => 1190 "Ancho" => 1585 "Tamanyo" => 435313 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epithelioid histiocytes and Langhans-type cells in the tuberculoid granulomas. Hematoxylin-eosin, original magnification ×20.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Jiménez-Gallo, N. Navas-García, C. Albarrán-Planelles, F. Guerrero-Sánchez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Jiménez-Gallo" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Navas-García" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Albarrán-Planelles" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Guerrero-Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012002311" "doi" => "10.1016/j.ad.2011.12.024" "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/S0001731012002311?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012003150?idApp=UINPBA000044" "url" => "/15782190/0000010300000010/v1_201304241352/S1578219012003150/v1_201304241352/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and research letter</span>" "titulo" => "Successful Treatment of Recalcitrant Chronic Foot Eczema with Alitertinoin" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "931" "paginaFinal" => "932" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Tejera-Vaquerizo, J.S. Sánchez-Vizcaíno, V. Haro-Gabaldón" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Tejera-Vaquerizo" "email" => array:1 [ 0 => "antoniotejera@aedv.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.S." "apellidos" => "Sánchez-Vizcaíno" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Haro-Gabaldón" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Infanta Margarita, Cabra-Córdoba, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento exitoso de un ezcema crónico recalcitrante de las plantas con alitretinoína" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2385 "Ancho" => 1585 "Tamanyo" => 283953 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Appearance of the eczema on the soles of the feet. B, Lateral view.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years, little attention has been paid to chronic foot eczema if we consider the numerous publications dedicated to eczema of the hands. However, chronic foot eczema is also a common problem and it can limit activity in some patients. The introduction of new therapeutic options, such as alitretinoin, for the management of chronic hand eczema resistant to conventional therapy led us to choose this drug in a patient with recalcitrant chronic foot eczema.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 49-year-old woman with a history of atopy and allergies to various nonsteroidal anti-inflammatory drugs was seen in our outpatient department for a 5-year history of eczema affecting both feet. She had been treated with emollients, high-potency topical corticosteroids, and several cycles of oral corticosteroids, which had achieved a slight improvement (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The eczema gave rise to constant itching associated with pain that sometimes disturbed her sleep and had caused occasional periods off work.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Standard patch testing following the guidelines of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) was positive for chromium, thiomersal, and the caines. Skin biopsy showed a subacute spongiotic dermatitis and microbiology cultures were negative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">After failure of therapy with topical calcineurin inhibitors (tacrolimus and pimecrolimus), treatment was started with oral ciclosporin at a dosage of 3<span class="elsevierStyleHsp" style=""></span>mg/kg/d in 2 daily doses, with a poor response at 12 weeks. In addition, the patient used chrome-free shoes. She was then treated with acitretin, 25<span class="elsevierStyleHsp" style=""></span>mg/d, which was discontinued after 1 month due to hypertriglyceridemia in the follow-up blood tests; there had been no response. In view of this lack of improvement, off-label use of alitretinoin was requested and treatment was started at a dosage of 30<span class="elsevierStyleHsp" style=""></span>mg/d, with a good response after the first week of treatment; complete clearance of the lesions was achieved at 1 month (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), and it was therefore decided to discontinue treatment. No adverse effects and no alterations of the blood tests were detected. During the third month of follow-up without treatment, the patient presented a further outbreak, and alitretinoin treatment was restarted at a dosage of 30<span class="elsevierStyleHsp" style=""></span>mg/d, which was continued until remission was achieved. She was subsequently administered the same dosage on alternate days, and continued on this regimen for 6 months, maintaining almost complete clearance of the lesions and with a marked improvement in her quality of life.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">There are geographical variations in the incidence of chronic foot eczema, and in a large proportion of cases it appears to be related to atopic eczema.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In general, there is a high prevalence of dermatoses affecting the feet. However, certain aspects, such as their repercussions on quality of life, have not been sufficiently investigated. In a large study, a considerable percentage of patients with dermatoses of the feet were found to have pain, discomfort on walking, and even a feeling of embarrassment and limitation of the activities of daily living.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment is usually similar to that of chronic hand eczema and includes emollients, topical corticosteroids, and calcineurin inhibitors; systemic treatments have included corticosteroids, traditional retinoids, ciclosporin, and UV radiation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Alitretinoin (9-cis-retinoic acid) is an isoform of isotretinoin (13-cis-retinoic acid), a retinoid that was specifically developed and approved for the treatment of chronic hand eczema. The exact mechanism of action of alitretinoin in chronic eczema is unknown, but it may interfere with at least 2 stages of the inflammatory process. In the early phases, it could interfere with chemokine production, reducing leukocyte migration, and it may also act within the leucocytes themselves, altering leukocyte activation modulated by antigen-antibody presentation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The efficacy of alitretinoin in chronic hand eczema resistant to topical corticosteroids has been demonstrated in a large double-blind study<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>; the dosage that achieved the best response was 30<span class="elsevierStyleHsp" style=""></span>mg/d, which achieved clearance for up to 24 weeks in 48% of patients, compared with 28% of patients for the 10<span class="elsevierStyleHsp" style=""></span>mg/d dosage and 17% of patients for placebo; the mean response time was 12.1 weeks. Those results are consistent with the results of a recent case series published in Spain.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the study by Ruzicka et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> recurrence of the lesions occurred in up to a third of patients who initially responded to alitretinoin after 24 weeks of follow-up. A recent study reported that a second course of treatment with alitretinoin at a dosage of 30<span class="elsevierStyleHsp" style=""></span>mg/d in patients who relapsed achieved clearance in up to 80% of cases, with good tolerance<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>; this would indicate that this medication could be used for long-term management of chronic hand eczema. Alitretinoin is therefore a useful and probably cost-effective treatment for this condition.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We have presented the case of a patient with chronic foot eczema that did not respond to various traditional treatments. Alitretinoin achieved complete clearance of the eczema. Alitretinoin could be a useful alternative for the management of patients with chronic foot eczema.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Tejera-Vaquerizo A, et al. Tratamiento exitoso de un ezcema crónico recalcitrante de las plantas con alitretinoína. Actas Dermosifiliogr. 2012;103:931–2.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2385 "Ancho" => 1585 "Tamanyo" => 283953 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Appearance of the eczema on the soles of the feet. B, Lateral view.</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" => 2353 "Ancho" => 1585 "Tamanyo" => 427056 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Complete resolution after 4 weeks of treatment with alitretinoin.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Food allergy and atopic eczema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Worth" 1 => "A. Sheikh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Curr Opin Allergy Clin Inmunol" "fecha" => "2010" "volumen" => "10" "paginaInicial" => "226" "paginaFinal" => "230" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of foot disease on quality of life: results of the Achilles Project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Katsambas" 1 => "D. Abeck" 2 => "E. Haneke" 3 => "P. van de Kerkhof" 4 => "T. Burzykowski" 5 => "G. Molenberghs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2004.01136.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2005" "volumen" => "19" "paginaInicial" => "191" "paginaFinal" => "195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15752289" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Redefining treatment options in chronic hand eczema (CHE)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Bissonnette" 1 => "T.L. Diepgen" 2 => "P. Elsner" 3 => "J. English" 4 => "R. Graham-Brown" 5 => "B. Homey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2010.03829.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2010" "volumen" => "24" "paginaInicial" => "1" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20831702" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Ruzicka" 1 => "C.W. Lynde" 2 => "G.B. Jemec" 3 => "T. Diepgen" 4 => "J. Berth-Jones" 5 => "P.J. Coenraads" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2008.08487.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2008" "volumen" => "158" "paginaInicial" => "808" "paginaFinal" => "817" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18294310" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respuesta al tratamiento con alitretinoína oral en ECM refractario con eczema crónico de manos refractario al tratamiento con corticoides tópicos potentes: nuestra experiencia en 15 pacientes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I.R. Agüayo-Leiva" 1 => "S. Urrutia" 2 => "P. Jaén-Olasolo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2010.10.012" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2011" "volumen" => "102" "paginaInicial" => "616" "paginaFinal" => "622" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21354545" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful retreatment with alitretinoin in patients with relapsed chronic hand eczema" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Bissonnette" 1 => "M. Worm" 2 => "B. Gerlach" 3 => "L. Guenther" 4 => "F. Cambazard" 5 => "T. Ruzicka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2009.09572.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2010" "volumen" => "162" "paginaInicial" => "420" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19906075" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-effectiveness of oral alitretinoin in patients with severe chronic hand eczema--a long-term analysis from a Swiss perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.R. Blank" 1 => "A.A. Blank" 2 => "T.D. Szucs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-5945-10-4" "Revista" => array:5 [ "tituloSerie" => "BMC Dermatol" "fecha" => "2010" "volumen" => "10" "paginaInicial" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20579358" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000010/v1_201304241352/S1578219012003162/v1_201304241352/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000010/v1_201304241352/S1578219012003162/v1_201304241352/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012003162?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 17 | 14 | 31 |
| 2024 Octubre | 116 | 57 | 173 |
| 2024 Septiembre | 140 | 48 | 188 |
| 2024 Agosto | 190 | 108 | 298 |
| 2024 Julio | 167 | 45 | 212 |
| 2024 Junio | 176 | 69 | 245 |
| 2024 Mayo | 175 | 39 | 214 |
| 2024 Abril | 141 | 40 | 181 |
| 2024 Marzo | 135 | 38 | 173 |
| 2024 Febrero | 135 | 44 | 179 |
| 2024 Enero | 127 | 50 | 177 |
| 2023 Diciembre | 171 | 37 | 208 |
| 2023 Noviembre | 372 | 46 | 418 |
| 2023 Octubre | 388 | 43 | 431 |
| 2023 Septiembre | 354 | 44 | 398 |
| 2023 Agosto | 282 | 20 | 302 |
| 2023 Julio | 434 | 67 | 501 |
| 2023 Junio | 396 | 30 | 426 |
| 2023 Mayo | 306 | 31 | 337 |
| 2023 Abril | 260 | 36 | 296 |
| 2023 Marzo | 299 | 42 | 341 |
| 2023 Febrero | 262 | 37 | 299 |
| 2023 Enero | 230 | 48 | 278 |
| 2022 Diciembre | 230 | 53 | 283 |
| 2022 Noviembre | 109 | 40 | 149 |
| 2022 Octubre | 151 | 27 | 178 |
| 2022 Septiembre | 189 | 33 | 222 |
| 2022 Agosto | 219 | 35 | 254 |
| 2022 Julio | 161 | 36 | 197 |
| 2022 Junio | 158 | 31 | 189 |
| 2022 Mayo | 355 | 53 | 408 |
| 2022 Abril | 424 | 55 | 479 |
| 2022 Marzo | 425 | 82 | 507 |
| 2022 Febrero | 397 | 39 | 436 |
| 2022 Enero | 417 | 46 | 463 |
| 2021 Diciembre | 289 | 48 | 337 |
| 2021 Noviembre | 337 | 52 | 389 |
| 2021 Octubre | 330 | 52 | 382 |
| 2021 Septiembre | 328 | 34 | 362 |
| 2021 Agosto | 387 | 47 | 434 |
| 2021 Julio | 411 | 37 | 448 |
| 2021 Junio | 295 | 41 | 336 |
| 2021 Mayo | 330 | 46 | 376 |
| 2021 Abril | 613 | 56 | 669 |
| 2021 Marzo | 262 | 44 | 306 |
| 2021 Febrero | 230 | 26 | 256 |
| 2021 Enero | 164 | 30 | 194 |
| 2020 Diciembre | 154 | 27 | 181 |
| 2020 Noviembre | 159 | 20 | 179 |
| 2020 Octubre | 186 | 16 | 202 |
| 2020 Septiembre | 198 | 24 | 222 |
| 2020 Agosto | 129 | 34 | 163 |
| 2020 Julio | 123 | 24 | 147 |
| 2020 Junio | 113 | 36 | 149 |
| 2020 Mayo | 88 | 41 | 129 |
| 2020 Abril | 50 | 33 | 83 |
| 2020 Marzo | 47 | 28 | 75 |
| 2020 Febrero | 6 | 12 | 18 |
| 2020 Enero | 4 | 10 | 14 |
| 2019 Diciembre | 4 | 10 | 14 |
| 2019 Noviembre | 4 | 6 | 10 |
| 2019 Octubre | 0 | 5 | 5 |
| 2019 Septiembre | 4 | 11 | 15 |
| 2019 Agosto | 4 | 13 | 17 |
| 2019 Julio | 4 | 25 | 29 |
| 2019 Junio | 4 | 21 | 25 |
| 2019 Mayo | 4 | 67 | 71 |
| 2019 Abril | 2 | 70 | 72 |
| 2019 Marzo | 0 | 17 | 17 |
| 2019 Febrero | 2 | 10 | 12 |
| 2019 Enero | 0 | 2 | 2 |
| 2018 Diciembre | 4 | 4 | 8 |
| 2018 Noviembre | 0 | 3 | 3 |
| 2018 Octubre | 3 | 2 | 5 |
| 2018 Septiembre | 3 | 9 | 12 |
| 2018 Agosto | 0 | 33 | 33 |
| 2018 Julio | 0 | 18 | 18 |
| 2018 Junio | 0 | 18 | 18 |
| 2018 Mayo | 0 | 17 | 17 |
| 2018 Abril | 0 | 9 | 9 |
| 2018 Marzo | 23 | 13 | 36 |
| 2018 Febrero | 143 | 9 | 152 |
| 2018 Enero | 107 | 18 | 125 |
| 2017 Diciembre | 170 | 13 | 183 |
| 2017 Noviembre | 112 | 17 | 129 |
| 2017 Octubre | 82 | 12 | 94 |
| 2017 Septiembre | 85 | 16 | 101 |
| 2017 Agosto | 89 | 13 | 102 |
| 2017 Julio | 69 | 15 | 84 |
| 2017 Junio | 91 | 31 | 122 |
| 2017 Mayo | 70 | 20 | 90 |
| 2017 Abril | 64 | 9 | 73 |
| 2017 Marzo | 60 | 13 | 73 |
| 2017 Febrero | 40 | 16 | 56 |
| 2017 Enero | 57 | 21 | 78 |
| 2016 Diciembre | 69 | 10 | 79 |
| 2016 Noviembre | 70 | 20 | 90 |
| 2016 Octubre | 119 | 15 | 134 |
| 2016 Septiembre | 169 | 12 | 181 |
| 2016 Agosto | 94 | 22 | 116 |
| 2016 Julio | 58 | 11 | 69 |
| 2016 Junio | 17 | 12 | 29 |
| 2016 Mayo | 3 | 8 | 11 |
| 2016 Abril | 7 | 2 | 9 |
| 2016 Marzo | 17 | 16 | 33 |
| 2016 Febrero | 5 | 12 | 17 |
| 2016 Enero | 8 | 8 | 16 |
| 2015 Diciembre | 4 | 1 | 5 |
| 2015 Noviembre | 18 | 1 | 19 |
| 2015 Octubre | 18 | 9 | 27 |
| 2015 Septiembre | 13 | 6 | 19 |
| 2015 Agosto | 11 | 5 | 16 |
| 2015 Julio | 118 | 15 | 133 |
| 2015 Junio | 93 | 7 | 100 |
| 2015 Mayo | 92 | 16 | 108 |
| 2015 Abril | 73 | 11 | 84 |
| 2015 Marzo | 53 | 15 | 68 |
| 2015 Febrero | 45 | 19 | 64 |
| 2015 Enero | 41 | 15 | 56 |
| 2014 Diciembre | 45 | 14 | 59 |
| 2014 Noviembre | 18 | 4 | 22 |
| 2014 Octubre | 41 | 8 | 49 |
| 2014 Septiembre | 17 | 4 | 21 |
| 2014 Agosto | 34 | 1 | 35 |
| 2014 Julio | 31 | 6 | 37 |
| 2014 Junio | 43 | 3 | 46 |
| 2014 Mayo | 48 | 8 | 56 |
| 2014 Abril | 42 | 9 | 51 |
| 2014 Marzo | 20 | 8 | 28 |
| 2014 Febrero | 18 | 11 | 29 |
| 2014 Enero | 17 | 10 | 27 |
| 2013 Diciembre | 28 | 4 | 32 |
| 2013 Noviembre | 23 | 9 | 32 |
| 2013 Octubre | 24 | 9 | 33 |
| 2013 Septiembre | 14 | 10 | 24 |
| 2013 Agosto | 9 | 8 | 17 |
| 2013 Julio | 11 | 19 | 30 |
| 2013 Junio | 8 | 26 | 34 |
| 2013 Mayo | 7 | 16 | 23 |
| 2013 Abril | 12 | 19 | 31 |
| 2013 Marzo | 19 | 18 | 37 |
| 2013 Febrero | 37 | 5 | 42 |
| 2013 Enero | 67 | 13 | 80 |
| 2012 Diciembre | 24 | 9 | 33 |
Mostrar todo
