Case and Research Letters
Mixed Panniculitis Secondary to Interferon Beta-1a Therapy in a Woman With Multiple Sclerosis
Paniculitis mixta secundaria al uso de interferón β 1A en una paciente con esclerosis múltiple
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Hematoxilina-eosina (HE) ×40. b) Se aprecia un infiltrado mixto, compuesto principalmente por linfocitos con algunos neutrófilos. HE ×200.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Cuesta, M. Moragón, M. Pérez-Crespo, J. Onrubia, M. García" "autores" => array:5 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Cuesta" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Moragón" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Pérez-Crespo" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Onrubia" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "García" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219013000450" "doi" => "10.1016/j.adengl.2012.06.028" "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/S1578219013000450?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012003432?idApp=UINPBA000044" "url" => "/00017310/0000010400000003/v1_201304241344/S0001731012003432/v1_201304241344/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219013000462" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.04.020" "estado" => "S300" "fechaPublicacion" => "2013-04-01" "aid" => "684" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:259-61" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3433 "formatos" => array:3 [ "EPUB" => 49 "HTML" => 2553 "PDF" => 831 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Porokeratosis of Mibelli: A New Indication for Photodynamic Therapy?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "259" "paginaFinal" => "261" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Poroqueratosis de mibelli, ¿una nueva indicación de la terapia fotodinámica?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1778 "Ancho" => 1335 "Tamanyo" => 435645 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin–eosin, original magnification ×20. Cornoid lamella (column of parakeratosis associated with hypogranulosis and dyskeratosis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Gutiérrez Paredes, R. Bella Navarro, E. Montesinos Villaescusa, E. Jordá Cuevas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Gutiérrez Paredes" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Bella Navarro" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Montesinos Villaescusa" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Jordá Cuevas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012003407" "doi" => "10.1016/j.ad.2012.04.016" "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/S0001731012003407?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000462?idApp=UINPBA000044" "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000462/v1_201304241622/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219013000449" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.04.019" "estado" => "S300" "fechaPublicacion" => "2013-04-01" "aid" => "677" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:255-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2720 "formatos" => array:3 [ "EPUB" => 53 "HTML" => 2088 "PDF" => 579 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Radiodermatitis with Signs of Eccrine Squamous Syringometaplasia Following a Diagnostic Procedure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "255" "paginaFinal" => "257" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Radiodermitis secundaria a procedimiento diagnóstico con signos de siringometaplasia escamosa ecrina" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 2812 "Ancho" => 1667 "Tamanyo" => 543800 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Hyperkeratosis and irregular acanthosis. Signs of epidermal dysmaturation: dyskeratotic cells, with keratinocytes of altered size and polarity, some of which are binucleated (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10). B, Eccrine duct in which areas of squamous metaplasia and a neutrophilic infiltrate can be observed inside the coil, as well as a moderate perieccrine inflammatory infiltrate (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J. Concha Garzón, M. Llamas-Velasco, J. Sánchez-Pérez, J. Fraga" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Concha Garzón" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Llamas-Velasco" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Sánchez-Pérez" ] 3 => array:2 [ "nombre" => "J." 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Cuesta, M. Moragón, M. Pérez-Crespo, J. Onrubia, M. García" "autores" => array:5 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Cuesta" "email" => array:1 [ 0 => "lcuestamontero@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Moragón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Pérez-Crespo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Onrubia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario San Juan, Alicante, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínico Universitario San Juan, Alicante, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paniculitis mixta secundaria al uso de interferón β 1A en una paciente con esclerosis múltiple" ] ] "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" => 1443 "Ancho" => 2167 "Tamanyo" => 583732 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">a, An infiltrate affecting the lobule and to a lesser extent, the septum. Septal thickening is also observed. Hematoxylin-eosin, original magnification ×40. b, Mixed infiltrate composed mainly of lymphocytes with some neutrophils. Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>200.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Interferon beta was approved in Spain in 1995 for the treatment of progressive multiple sclerosis. There are 2 main types, interferon beta-1a and 1b, both of which are sold in a variety of formulations, resulting in a range of responses to the same molecule. Local skin reactions are a common adverse effect, and are usually self-limiting. By contrast, panniculitis and lipoatrophy are very rare, and may necessitate discontinuation of treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a 43-year-old woman who was diagnosed in 2005 with multiple sclerosis, for which she received several disease-modifying treatments. In October 2009, she began treatment with interferon beta-1a (Rebif 44), which was self-administered subcutaneously 3 times a week, with a favorable response. After 18 months of treatment, induration was observed at the injection sites, on the back of the thighs, and on the outer arms. A few weeks later, ulcerated lesions appeared on the front of the thighs and progressively increased in size. The patient reported that the plaques caused severe pain, which made moving and walking difficult. She reported no fever or systemic upset and her neurological status remained unchanged.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Examination revealed 2 ulcers on the front of the thighs of 1<span class="elsevierStyleHsp" style=""></span>cm diameter. The borders of the ulcers had a scarlike appearance and beneath the ulcers were cavities of about 4<span class="elsevierStyleHsp" style=""></span>cm in diameter. An indurated plaque of about 15<span class="elsevierStyleHsp" style=""></span>cm in diameter, with a slightly erythematous surface, surrounded the ulcer and was intensely painful to touch (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). These indurated plaques were also present on the external aspect of both arms, although no ulcers were observed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Tissue culture of the ulcers and an incisional biopsy of a plaque from 1 of the thighs were negative. Histopathology revealed a preserved epidermis, sclerosis of the middle and deep dermis, and subcutaneous tissue involvement. At higher magnification we detected an infiltrate that primarily affected the lobule, although septal thickening was also observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>a); this infiltrate was composed mainly of neutrophils and lymphocytes (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>b). No vasculitis or necrosis was observed. Based on these observations, the patient was diagnosed with mixed panniculitis secondary to interferon beta-1a therapy. Upon consultation with her neurologist, it was decided to discontinue interferon beta-1a treatment, mainly due to functional impairment.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Interferon beta-1a was approved for the treatment of progressive multiple sclerosis in Spain in 1995. Its administration decreases the relapse rate by 30% and the appearance of new lesions on magnetic resonance imaging by 66%. Local skin manifestations such as erythema and pain are well-described frequent adverse effects; they occur in 63% to 85% of patients<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> but are usually self-limiting and do not require discontinuation of treatment. However, treatment may need to be discontinued in cases of other more serious reactions such as ulcerations, necrosis,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> sclerosis, and induration at the injection site. Other adverse effects such as sarcoid granulomas, lipoatrofia,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> lupus-like lesions,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and septal or lobular panniculitis<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> are considered very rare. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the cases of panniculitis secondary to interferon treatment described to date. Some authors have suggested that this form of panniculitis may be caused by the vascular toxicity of interferon beta.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In 2009, Ball and coworkers<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> reported that interferon beta-induced panniculitis can mimic pancreatic panniculitis; differential diagnosis in such cases may be facilitated by lipase and amylase tests.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Two theories have been proposed regarding the pathophysiology of panniculitis secondary to interferon beta treatment. The first proposes that the stress associated with self-injection plays a key role in triggering this condition. The second theory attributes greater importance to the immunological effects of interferon beta. According to the latter theory, the resulting symptoms reflect activation of the immune system and may be an indication of treatment effectiveness.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The management of patients with panniculitis secondary to interferon beta treatment remains unsatisfactory. It is essential that patients are shown how to correctly self-administer the injection, which should be subcutaneous and never intradermal, and to rotate the injection sites daily. Application of these measures leads to improvements in the majority of lesions,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> although in some cases suspension of interferon beta treatment may be necessary, a decision that should be made in collaboration with the other specialists treating the patient.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Cuesta L, et al. Paniculitis mixta secundaria al uso de interferón β 1A en una paciente con esclerosis múltiple. Actas Dermosifiliogr. 2013;104:257–9.</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" => 1252 "Ancho" => 1667 "Tamanyo" => 127300 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Indurated erythematous plaques with ulcerated centers on the front of both thighs.</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" => 1443 "Ancho" => 2167 "Tamanyo" => 583732 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">a, An infiltrate affecting the lobule and to a lesser extent, the septum. Septal thickening is also observed. Hematoxylin-eosin, original magnification ×40. b, Mixed infiltrate composed mainly of lymphocytes with some neutrophils. Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>200.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "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="" 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, 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">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">Onset of Symptoms \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">Clinical Symptoms \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">Pathological Findings \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">Nakamura et al.,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>2008 \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">43, 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">Buttocks \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 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythema, induration, and pain \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">Perivascular dermatitis and lobular and septal panniculitis with lymphocytic infiltrate \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">Ziegler et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>1998 \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">41, 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">Legs \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">8 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythema, induration, and pain \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">Perivascular infiltrate and lobular panniculitis with lymphocytic infiltrate \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">Heinzerling et al.,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>2002 \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">44, 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">Arms, legs and abdomen \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">4 y \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">Painful induration \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">Septal panniculitis with predominantly lymphocytic infiltrate \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">O'Sullivan et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>2006 \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">37, 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">Left leg \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 y, 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">Erythema and pain \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">Septal panniculitis with inflammatory infiltrate \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">Ball et al.,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>2009 \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, 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">Not recorded \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 y, 10 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">Pain and induration \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">Lobular panniculitis with neutrophilic infiltrate \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">Ball et al.,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>2009 \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, 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">Not recorded \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">6 y, 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">Cellulitis \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">Lipomembranous panniculitis \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">Poulin et al.,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>2009 \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">43, 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">Abdomen \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">9 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythema, pain, and fever \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">Septal panniculitis with predominantly lymphocytic infiltrate \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">Present case \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">43, 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">Legs \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">19 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">Pain, erythema, induration, and functional impairment \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">Lobular and septal panniculitis with mixed inflammatory infiltrate (lymphocytes and neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183301.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients Described in the Literature Who Developed Panniculitis After Interferon Administration.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interferon beta-1b injection site reactions and necroses" "autores" => array:1 [ 0 => array:2 [ "etal" => false 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Hashimoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0560.2008.01019.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2009" "volumen" => "36" "paginaInicial" => "331" "paginaFinal" => "337" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19032383" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interferon beta-induced panniculitis mimicking acute appendicitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Poulin" 1 => "P. Rico" 2 => "J. Côté" 3 => "L.R. Bégin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2009.106" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2009" "volumen" => "145" "paginaInicial" => "916" "paginaFinal" => "917" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19687423" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000450/v1_201304241622/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/15782190/0000010400000003/v1_201304241622/S1578219013000450/v1_201304241622/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000450?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 15 | 26 |
| 2024 Octubre | 72 | 39 | 111 |
| 2024 Septiembre | 102 | 38 | 140 |
| 2024 Agosto | 103 | 43 | 146 |
| 2024 Julio | 97 | 42 | 139 |
| 2024 Junio | 91 | 41 | 132 |
| 2024 Mayo | 85 | 36 | 121 |
| 2024 Abril | 71 | 21 | 92 |
| 2024 Marzo | 81 | 24 | 105 |
| 2024 Febrero | 62 | 36 | 98 |
| 2024 Enero | 90 | 38 | 128 |
| 2023 Diciembre | 76 | 22 | 98 |
| 2023 Noviembre | 141 | 29 | 170 |
| 2023 Octubre | 135 | 25 | 160 |
| 2023 Septiembre | 164 | 31 | 195 |
| 2023 Agosto | 81 | 24 | 105 |
| 2023 Julio | 76 | 29 | 105 |
| 2023 Junio | 65 | 23 | 88 |
| 2023 Mayo | 77 | 26 | 103 |
| 2023 Abril | 60 | 20 | 80 |
| 2023 Marzo | 52 | 14 | 66 |
| 2023 Febrero | 40 | 21 | 61 |
| 2023 Enero | 43 | 27 | 70 |
| 2022 Diciembre | 64 | 31 | 95 |
| 2022 Noviembre | 36 | 20 | 56 |
| 2022 Octubre | 46 | 27 | 73 |
| 2022 Septiembre | 52 | 38 | 90 |
| 2022 Agosto | 31 | 31 | 62 |
| 2022 Julio | 41 | 33 | 74 |
| 2022 Junio | 43 | 27 | 70 |
| 2022 Mayo | 84 | 28 | 112 |
| 2022 Abril | 59 | 30 | 89 |
| 2022 Marzo | 64 | 48 | 112 |
| 2022 Febrero | 49 | 31 | 80 |
| 2022 Enero | 66 | 33 | 99 |
| 2021 Diciembre | 48 | 36 | 84 |
| 2021 Noviembre | 41 | 38 | 79 |
| 2021 Octubre | 80 | 47 | 127 |
| 2021 Septiembre | 58 | 36 | 94 |
| 2021 Agosto | 44 | 18 | 62 |
| 2021 Julio | 55 | 38 | 93 |
| 2021 Junio | 35 | 29 | 64 |
| 2021 Mayo | 35 | 29 | 64 |
| 2021 Abril | 81 | 70 | 151 |
| 2021 Marzo | 82 | 24 | 106 |
| 2021 Febrero | 85 | 28 | 113 |
| 2021 Enero | 43 | 20 | 63 |
| 2020 Diciembre | 47 | 13 | 60 |
| 2020 Noviembre | 32 | 4 | 36 |
| 2020 Octubre | 26 | 14 | 40 |
| 2020 Septiembre | 21 | 8 | 29 |
| 2020 Agosto | 41 | 19 | 60 |
| 2020 Julio | 24 | 17 | 41 |
| 2020 Junio | 38 | 20 | 58 |
| 2020 Mayo | 29 | 13 | 42 |
| 2020 Abril | 31 | 24 | 55 |
| 2020 Marzo | 41 | 14 | 55 |
| 2020 Febrero | 2 | 2 | 4 |
| 2020 Enero | 0 | 4 | 4 |
| 2019 Diciembre | 4 | 8 | 12 |
| 2019 Noviembre | 0 | 8 | 8 |
| 2019 Octubre | 1 | 2 | 3 |
| 2019 Septiembre | 4 | 7 | 11 |
| 2019 Agosto | 0 | 5 | 5 |
| 2019 Julio | 0 | 11 | 11 |
| 2019 Junio | 2 | 3 | 5 |
| 2019 Mayo | 0 | 3 | 3 |
| 2019 Abril | 0 | 9 | 9 |
| 2019 Marzo | 2 | 17 | 19 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Agosto | 0 | 4 | 4 |
| 2018 Junio | 0 | 6 | 6 |
| 2018 Mayo | 0 | 4 | 4 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Marzo | 1 | 3 | 4 |
| 2018 Febrero | 121 | 7 | 128 |
| 2018 Enero | 104 | 5 | 109 |
| 2017 Diciembre | 114 | 4 | 118 |
| 2017 Noviembre | 80 | 9 | 89 |
| 2017 Octubre | 56 | 6 | 62 |
| 2017 Septiembre | 63 | 5 | 68 |
| 2017 Agosto | 80 | 11 | 91 |
| 2017 Julio | 67 | 9 | 76 |
| 2017 Junio | 95 | 10 | 105 |
| 2017 Mayo | 67 | 14 | 81 |
| 2017 Abril | 50 | 10 | 60 |
| 2017 Marzo | 59 | 7 | 66 |
| 2017 Febrero | 41 | 10 | 51 |
| 2017 Enero | 92 | 14 | 106 |
| 2016 Diciembre | 87 | 9 | 96 |
| 2016 Noviembre | 146 | 7 | 153 |
| 2016 Octubre | 177 | 12 | 189 |
| 2016 Septiembre | 223 | 16 | 239 |
| 2016 Agosto | 209 | 8 | 217 |
| 2016 Julio | 74 | 10 | 84 |
| 2016 Junio | 6 | 15 | 21 |
| 2016 Mayo | 4 | 11 | 15 |
| 2016 Abril | 6 | 9 | 15 |
| 2016 Marzo | 4 | 1 | 5 |
| 2016 Febrero | 5 | 16 | 21 |
| 2016 Enero | 9 | 1 | 10 |
| 2015 Diciembre | 7 | 9 | 16 |
| 2015 Noviembre | 35 | 14 | 49 |
| 2015 Octubre | 34 | 13 | 47 |
| 2015 Septiembre | 21 | 5 | 26 |
| 2015 Agosto | 9 | 4 | 13 |
| 2015 Julio | 232 | 12 | 244 |
| 2015 Junio | 118 | 13 | 131 |
| 2015 Mayo | 153 | 19 | 172 |
| 2015 Abril | 116 | 16 | 132 |
| 2015 Marzo | 102 | 8 | 110 |
| 2015 Febrero | 119 | 5 | 124 |
| 2015 Enero | 67 | 2 | 69 |
| 2014 Diciembre | 80 | 3 | 83 |
| 2014 Noviembre | 59 | 3 | 62 |
| 2014 Octubre | 72 | 2 | 74 |
| 2014 Septiembre | 86 | 3 | 89 |
| 2014 Agosto | 66 | 4 | 70 |
| 2014 Julio | 63 | 3 | 66 |
| 2014 Junio | 83 | 5 | 88 |
| 2014 Mayo | 66 | 8 | 74 |
| 2014 Abril | 60 | 6 | 66 |
| 2014 Marzo | 66 | 12 | 78 |
| 2014 Febrero | 40 | 8 | 48 |
| 2014 Enero | 42 | 7 | 49 |
| 2013 Diciembre | 25 | 10 | 35 |
| 2013 Noviembre | 16 | 6 | 22 |
| 2013 Octubre | 5 | 7 | 12 |
| 2013 Septiembre | 14 | 3 | 17 |
| 2013 Agosto | 7 | 7 | 14 |
| 2013 Julio | 3 | 1 | 4 |
| 2013 Junio | 2 | 5 | 7 |
| 2013 Mayo | 0 | 5 | 5 |
| 2013 Abril | 1 | 2 | 3 |
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