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Guinovart, I. Bielsa, G. Pintos-Morell, C. Ferrándiz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R.M." "apellidos" => "Guinovart" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Bielsa" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Pintos-Morell" ] 3 => array:2 [ "nombre" => "C." 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"tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "259" "paginaFinal" => "261" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Gutiérrez Paredes, R. Bella Navarro, E. Montesinos Villaescusa, E. Jordá Cuevas" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Gutiérrez Paredes" "email" => array:1 [ 0 => "ev_gutierrez@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Bella Navarro" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Montesinos Villaescusa" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Jordá Cuevas" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Poroqueratosis de mibelli, ¿una nueva indicación de la terapia fotodinámica?" ] ] "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>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Porokeratosis is a skin keratinization disorder that gives rise to a number of clinical variants; the underlying disorder can be acquired or hereditary. Clinically, it presents as a macule or annular plaque characterized by a central atrophic patch surrounded by a clearly defined hyperkeratotic border. Histology shows a compact parakeratotic column known as a cornoid lamella. The various clinical forms of the disease are defined by the number and distribution of the lesions: porokeratosis of Mibelli, disseminated superficial actinic porokeratosis, linear porokeratosis, porokeratosis palmaris et plantaris disseminata, and punctate porokeratosis. Although the lesions are benign, some of their characteristics are associated with a greater risk of malignant transformation, hence the importance of deciding how to approach these lesions and knowing the different therapeutic options available.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of an 82-year-old woman with no relevant personal medical history, who visited our department with a skin lesion on the anterior aspect of her left leg that had grown gradually over 2-3 years. The solitary, erythematous, rounded plaque measuring 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm had well defined margins and was covered by a whitish scale (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The results of a skin biopsy revealed cornoid lamellae with no signs of cellular atypia (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). On the basis of both the clinical examination and histology report, a diagnosis of porokeratosis of Mibelli was established. Because of the size and location of the lesion, photodynamic therapy (PDT) was proposed as a good therapeutic option. A cream containing methyl 5-aminolevulinate (MAL) was applied to the lesion, which was then covered with occlusive dressings for 3<span class="elsevierStyleHsp" style=""></span>hours. The cream used was Metvix. Upon removal of the dressings, the whole surface of the lesion was observed to emit intense red fluorescence under ultraviolet light. The lesion was then exposed to red light from an LED lamp (Aktilite, 37<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>) for 9<span class="elsevierStyleHsp" style=""></span>minutes. Two weeks later, the area of treated skin was ulcerated, perhaps as a result of exposure of the lesion to sunlight a few hours after the treatment; a new session of PDT was therefore ruled out and local therapies were prescribed. Three months after the PDT session, the lesion had almost completely resolved and only a slightly erythematous, crusted area remained (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The pathogenesis of porokeratosis is still poorly understood and the disorder is thought to be the result of the proliferation of abnormal clones of keratinocytes induced by the interaction of genetic factors, immunosuppression, and environmental triggers such as exposure to sunlight. The association with irradiation explains why the lesions are more often located in sun-exposed areas of the body and are more evident in summer.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Although these chronic lesions are benign, all clinical forms of porokeratosis are associated with some risk of malignant transformation. Large, long-standing, or linear lesions and those that present in elderly or immunocompromised patients have the greatest risk of malignant transformation.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Reported neoplasms, in order of frequency, are Bowen disease, epidermoid carcinoma, and basal cell carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Because of the risk of malignancy, it is important to consider the best approach to take when presented with this dermatosis and to know the different therapeutic options available.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The fact that many different therapies are used is indicative of the lack of an ideal treatment that is safe and effective; each case should therefore be evaluated on an individual basis. In the case of multiple, disseminated lesions, the most appropriate approach may be watchful waiting and biopsy of the lesions in which malignant transformation is suspected.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Usual treatments include the following: calcipotriol, tacalcitol, 5-fluorouracil, imiquimod, topical and systemic retinoids, laser therapy, cryotherapy, dermabrasion, and surgical excision.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> PDT is approved for the treatment of actinic keratosis, superficial and nodular basal cell carcinoma, and Bowen disease. Its use has recently been extended to a number of infectious and inflammatory skin disorders and certain cancers; the results reported to date indicate varying degrees of efficacy.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> PDT has been used to treat porokeratosis on the basis of the clinical and histological similarities between this disorder and actinic keratosis. Moreover, it is a safe, well tolerated technique associated with good cosmetic results and minimal side effects. However, the results of the few documented cases are contradictory. Most studies have been carried out in patients with disseminated superficial actinic porokeratosis and various photosensitizing agents have been used (δ-aminolevulinic acid, MAL, and hypericin), all with poor results. The lesions resolved in only 1 case,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and improved slightly or remained unchanged in the others.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> In the literature, we found only 1 case of porokeratosis of Mibelli that had been successfully treated with PDT. Unlike our case, those authors used a single session of PDT with MAL and blue light in combination with daily application of 5-fluorouracil cream.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> While the normal PDT regimen in the treatment of most skin disorders involves more than 1 session, we were only able to apply a single session in the present case owing to the appearance of side effects, and this may explain the incomplete response obtained. However, it is also possible that the immunomodulatory effect of PDT and the inflammation already present in the lesion (visible in the clinical and histological images) may have favored a good therapeutic response with just 1 session. Ulceration is a rare adverse event,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and its appearance was probably due in some measure to the fact that the patient was an elderly woman and the leg was exposed to sunlight after treatment, contrary to express instructions.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, we report a case of porokeratosis of Mibelli in which treatment with PDT obtained a partial response. Nevertheless, because the results achieved with photodynamic therapy in the treatment of porokeratosis are highly varied, we believe that further studies with larger series of cases are needed if we are to reach clear conclusions regarding its utility in this setting.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Gutiérrez Paredes E, et al. Poroqueratosis de mibelli, ¿ una nueva indicación de la terapia fotodinámica? Actas Dermosifiliogr. 2013;104:259–61.</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" => 1778 "Ancho" => 1335 "Tamanyo" => 303348 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous plaque measuring 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm, covered with a thick, whitish scale.</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" => 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>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1778 "Ancho" => 1335 "Tamanyo" => 222041 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mild erythema and desquamation 3 months after the photodynamic therapy session.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of porokeratosis of Mibelli with combined use of photodynamic therapy and fluorouracil cream" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. 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año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 22 | 13 | 35 |
2024 Octubre | 118 | 72 | 190 |
2024 Septiembre | 147 | 45 | 192 |
2024 Agosto | 146 | 77 | 223 |
2024 Julio | 120 | 44 | 164 |
2024 Junio | 148 | 47 | 195 |
2024 Mayo | 99 | 42 | 141 |
2024 Abril | 92 | 23 | 115 |
2024 Marzo | 98 | 47 | 145 |
2024 Febrero | 97 | 37 | 134 |
2024 Enero | 74 | 43 | 117 |
2023 Diciembre | 100 | 32 | 132 |
2023 Noviembre | 110 | 38 | 148 |
2023 Octubre | 128 | 38 | 166 |
2023 Septiembre | 104 | 38 | 142 |
2023 Agosto | 90 | 37 | 127 |
2023 Julio | 109 | 42 | 151 |
2023 Junio | 106 | 46 | 152 |
2023 Mayo | 154 | 42 | 196 |
2023 Abril | 107 | 37 | 144 |
2023 Marzo | 101 | 41 | 142 |
2023 Febrero | 70 | 21 | 91 |
2023 Enero | 51 | 32 | 83 |
2022 Diciembre | 68 | 47 | 115 |
2022 Noviembre | 48 | 40 | 88 |
2022 Octubre | 42 | 27 | 69 |
2022 Septiembre | 59 | 50 | 109 |
2022 Agosto | 44 | 33 | 77 |
2022 Julio | 70 | 41 | 111 |
2022 Junio | 36 | 21 | 57 |
2022 Mayo | 46 | 31 | 77 |
2022 Abril | 55 | 43 | 98 |
2022 Marzo | 76 | 47 | 123 |
2022 Febrero | 79 | 20 | 99 |
2022 Enero | 71 | 39 | 110 |
2021 Diciembre | 75 | 45 | 120 |
2021 Noviembre | 93 | 36 | 129 |
2021 Octubre | 98 | 46 | 144 |
2021 Septiembre | 88 | 43 | 131 |
2021 Agosto | 72 | 25 | 97 |
2021 Julio | 98 | 38 | 136 |
2021 Junio | 102 | 39 | 141 |
2021 Mayo | 81 | 41 | 122 |
2021 Abril | 147 | 80 | 227 |
2021 Marzo | 100 | 27 | 127 |
2021 Febrero | 93 | 35 | 128 |
2021 Enero | 70 | 18 | 88 |
2020 Diciembre | 48 | 18 | 66 |
2020 Noviembre | 34 | 16 | 50 |
2020 Octubre | 35 | 8 | 43 |
2020 Septiembre | 30 | 10 | 40 |
2020 Agosto | 43 | 20 | 63 |
2020 Julio | 39 | 17 | 56 |
2020 Junio | 39 | 20 | 59 |
2020 Mayo | 24 | 17 | 41 |
2020 Abril | 37 | 22 | 59 |
2020 Marzo | 32 | 21 | 53 |
2020 Febrero | 3 | 14 | 17 |
2020 Enero | 0 | 8 | 8 |
2019 Diciembre | 4 | 8 | 12 |
2019 Noviembre | 0 | 6 | 6 |
2019 Octubre | 0 | 4 | 4 |
2019 Septiembre | 4 | 2 | 6 |
2019 Agosto | 2 | 6 | 8 |
2019 Julio | 0 | 12 | 12 |
2019 Junio | 12 | 11 | 23 |
2019 Mayo | 0 | 35 | 35 |
2019 Abril | 0 | 49 | 49 |
2019 Marzo | 2 | 19 | 21 |
2019 Febrero | 0 | 2 | 2 |
2019 Enero | 2 | 4 | 6 |
2018 Diciembre | 5 | 2 | 7 |
2018 Noviembre | 3 | 0 | 3 |
2018 Octubre | 3 | 0 | 3 |
2018 Septiembre | 4 | 2 | 6 |
2018 Agosto | 0 | 3 | 3 |
2018 Julio | 0 | 1 | 1 |
2018 Junio | 0 | 4 | 4 |
2018 Mayo | 0 | 13 | 13 |
2018 Abril | 0 | 2 | 2 |
2018 Marzo | 6 | 1 | 7 |
2018 Febrero | 38 | 8 | 46 |
2018 Enero | 54 | 12 | 66 |
2017 Diciembre | 66 | 5 | 71 |
2017 Noviembre | 43 | 12 | 55 |
2017 Octubre | 59 | 10 | 69 |
2017 Septiembre | 50 | 13 | 63 |
2017 Agosto | 48 | 26 | 74 |
2017 Julio | 46 | 9 | 55 |
2017 Junio | 81 | 15 | 96 |
2017 Mayo | 51 | 14 | 65 |
2017 Abril | 68 | 16 | 84 |
2017 Marzo | 48 | 7 | 55 |
2017 Febrero | 46 | 10 | 56 |
2017 Enero | 49 | 18 | 67 |
2016 Diciembre | 52 | 12 | 64 |
2016 Noviembre | 101 | 14 | 115 |
2016 Octubre | 98 | 23 | 121 |
2016 Septiembre | 143 | 14 | 157 |
2016 Agosto | 110 | 21 | 131 |
2016 Julio | 57 | 6 | 63 |
2016 Junio | 7 | 10 | 17 |
2016 Mayo | 5 | 9 | 14 |
2016 Abril | 4 | 16 | 20 |
2016 Marzo | 4 | 15 | 19 |
2016 Febrero | 6 | 2 | 8 |
2016 Enero | 6 | 2 | 8 |
2015 Diciembre | 4 | 3 | 7 |
2015 Noviembre | 7 | 1 | 8 |
2015 Octubre | 5 | 2 | 7 |
2015 Septiembre | 8 | 2 | 10 |
2015 Agosto | 13 | 2 | 15 |
2015 Julio | 92 | 110 | 202 |
2015 Junio | 78 | 11 | 89 |
2015 Mayo | 100 | 24 | 124 |
2015 Abril | 69 | 12 | 81 |
2015 Marzo | 43 | 5 | 48 |
2015 Febrero | 45 | 3 | 48 |
2015 Enero | 37 | 6 | 43 |
2014 Diciembre | 49 | 4 | 53 |
2014 Noviembre | 28 | 7 | 35 |
2014 Octubre | 47 | 2 | 49 |
2014 Septiembre | 29 | 7 | 36 |
2014 Agosto | 25 | 4 | 29 |
2014 Julio | 22 | 7 | 29 |
2014 Junio | 43 | 6 | 49 |
2014 Mayo | 59 | 7 | 66 |
2014 Abril | 43 | 3 | 46 |
2014 Marzo | 47 | 15 | 62 |
2014 Febrero | 42 | 7 | 49 |
2014 Enero | 56 | 5 | 61 |
2013 Diciembre | 35 | 11 | 46 |
2013 Noviembre | 37 | 8 | 45 |
2013 Octubre | 21 | 3 | 24 |
2013 Septiembre | 30 | 8 | 38 |
2013 Agosto | 25 | 8 | 33 |
2013 Julio | 12 | 4 | 16 |
2013 Junio | 7 | 5 | 12 |
2013 Mayo | 5 | 5 | 10 |
2013 Abril | 3 | 4 | 7 |