Case and Research Letters
Extramammary Paget Disease with Frontotemporal Involvement: A Case Report and Review of the Literature
Enfermedad de Paget extramamaria con afectación de la región fronto-temporal. Presentación de un caso y revisión de la bibliografía
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Presentación de un caso y revisión de la bibliografía" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "355" "paginaFinal" => "357" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Extramammary Paget Disease with Frontotemporal Involvement: A Case Report and Review of the Literature" ] ] "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" => 1745 "Ancho" => 800 "Tamanyo" => 293628 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Placa eritematosa de 5<span class="elsevierStyleHsp" style=""></span>cm de tamaño, con pigmentación lineal en la periferia localizada en área temporal derecha, que se extiende hacia piel preauricular no pilosa. 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Revisión de 7 casos" ] ] "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" => 1828 "Ancho" => 2500 "Tamanyo" => 877507 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histologic features of angiolymphoid hyperplasia. A, Hematoxylin-eosin, original magnification ×40. B, Hematoxylin-eosin, original magnification ×100. C, Hematoxylin-eosin, original magnification ×200. D, Dermoscopic image of angiolymphoid hyperplasia.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Padilla-España, T. Fernández-Morano, J. del Boz, R. Fúnez-Liébana" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." 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Córdoba, M.E. Iglesias, I. Rodríguez, J.I. Yanguas" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Córdoba" "email" => array:1 [ 0 => "acordobi@cfnavarra.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" => "M.E." "apellidos" => "Iglesias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.I." "apellidos" => "Yanguas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, 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" => "Enfermedad de Paget extramamaria con afectación de la región fronto-temporal. Presentación de un caso y revisión de la bibliografía" ] ] "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" => 2908 "Ancho" => 1333 "Tamanyo" => 544372 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Erythematous plaque measuring 5<span class="elsevierStyleHsp" style=""></span>cm located in the right temporal region and extending towards preauricular hairless skin, with a periphery marked by linear pigmentation. B, Plaque displaying intense red fluorescence after a 3-hour incubation period with methyl aminolevulinate. C, Complete remission 2 months after the second photodynamic therapy session.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Extramammary Paget disease (EMPD), first described by Crocker<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1889, is a form of intraepidermal adenocarcinoma that generally occurs in areas with a high density of apocrine glands. It presents as a scaly, erythematous lesion simulating inflammatory conditions, tumors, and infections. Isolated cases that occur in locations where there are usually no apocrine glands are called ectopic EMPD.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We report a case of EMPD in the right frontotemporal region, which is only the third case of EMPD affecting the face that has been reported in the literature (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A 64-year-old woman presented with a plaque measuring 5<span class="elsevierStyleHsp" style=""></span>cm in the right frontotemporal region that extended into the preauricular region; the lesion had appeared 3 years earlier. The plaque had an erythematous, slightly scaly center and slightly pigmented borders (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A diagnosis of intraepidermal squamous cell carcinoma or seborrheic dermatitis was made and treatment with corticosteroids resulted in a slight improvement.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histologic study of 2 biopsies, 1 from the center and 1 from the edge of the lesion, revealed the occupation of the epidermis by a population of large cells with clear cytoplasm and atypical nuclei, arranged singly or in nests and accompanied by little melanin pigment. These cells had spread to the adnexa but there was no dermal infiltration (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> A and B). The atypical cells occupying the epidermis were positive for cytokeratin 7 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>G) and cytokeratin CAM 5.2, but these markers were not expressed in the surrounding epidermis. The nuclei tested positive for estrogen receptors (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Her2 membrane expression was intense and continuous (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D). Other positive markers were carcinoembryonic antigen (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>E), gross cystic disease fluid protein 15 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>H), and MUC-1 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>F). The lesion was S-100 negative. These findings led to a diagnosis of ectopic EMPD.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In view of the size of the plaque, we considered that surgery as a first choice would probably be disfiguring or offer unsatisfactory esthetic results for a 64-year-old patient. Photodynamic therapy was performed in 2 sessions with a week between them. Topical methyl aminolevulinate was applied in accordance with the protocol of the dermatology department. Under Wood light, fluorescence was observed in the lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). A very good response to treatment was observed in the follow-up visit 2 months after the second session of photodynamic therapy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The lesion recurred partially 18 months after treatment. We therefore prescribed a second cycle of 2 sessions of photodynamic therapy, which led to a partial response. On the last visit imiquimod treatment was added to the regimen.</p><p id="par0025" class="elsevierStylePara elsevierViewall">EMPD affecting facial skin was first described in 2002 by Chilukuri et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in a 67-year-old male patient who had an erythematous plaque on the cheek that had appeared 10 years earlier and had been treated as Bowen disease. In 2004 another case affecting the face was reported,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> presenting in a 61-year-old man in the form of a pink plaque in the frontotemporal region near the left lateral canthus. In both cases the treatment chosen was Mohs micrographic surgery.The differential diagnosis of EMPD in the frontotemporal area should be established with seborrheic dermatitis, nummular eczema, Bowen disease and, less frequently, with lichen-sclerosus et atrophicus and lichen simplex chronicus. The histological differential diagnosis should be made with other malignancies that occupy the epidermis and are characterized by cells with clear cytoplasm and patchy distribution, mainly superficial spreading melanoma and malignant lentigo, in which case the epithelial markers would be negative and the melanocytic markers (S-100, Melan-A, HMB-45, etc.) positive. P63 can be used to differentiate EMPD from the Pagetoid variant of Bowen disease.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In general, EMPD is only locally aggressive. However, in cases of advanced or metastatic EMPD,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> systemic chemotherapy is indicated.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7,9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Surgery is the treatment of choice in EMPD.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> However, recurrence rates are high even when the lesions are removed with wide surgical margins. Recurrence is probably due to the multifocal nature of the disease and subclinical involvement of skin that is apparently unaffected. Recurrence rates are higher in cases of invasive disease.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7</span></a> The use of Mohs micrographic surgery improves cure rates but does not prevent recurrence. Radiation therapy may be useful as adjuvant therapy in patients at high risk of recurrence.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Because EMPD has a patchy distribution and the affected area often extends beyond the clinically visible tumor, photodynamic therapy may be a useful treatment when there is intraepithelial involvement and surgery is high-risk or when there is a high risk of morbidity due to the anatomical location of the lesion. However, because of the small number of studies and case reports of patients treated with this technique, photodynamic therapy should only be used when other approaches are not feasible.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We report the third case of EMPD affecting the face (the frontotemporal region). We call attention to the need to include this disease in the list of lesions that simulate other dermatoses and to the fact that its diagnosis requires immunohistochemical evaluation of the usual breast tumor markers. Ours is the first case treated with photodynamic therapy. The patient achieved complete temporary remission, so this treatment may be a good therapeutic option when involvement is exclusively intraepidermal and when a surgical approach is difficult.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Córdoba A, et al. Enfermedad de Paget extramamaria con afectación de la región fronto-temporal. Presentación de un caso y revisión de la bibliografía. Actas Dermosifiliogr. 2013;104:355–7.</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" => 2908 "Ancho" => 1333 "Tamanyo" => 544372 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Erythematous plaque measuring 5<span class="elsevierStyleHsp" style=""></span>cm located in the right temporal region and extending towards preauricular hairless skin, with a periphery marked by linear pigmentation. B, Plaque displaying intense red fluorescence after a 3-hour incubation period with methyl aminolevulinate. C, Complete remission 2 months after the second photodynamic therapy session.</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" => 2388 "Ancho" => 2167 "Tamanyo" => 1112655 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B, Histologic images of the lesion showing isolated clear cells in the epidermis (hematoxylin-eosin, original magnification ×400). C, Nuclear expression of estrogen receptors in the atypical cells (hematoxylin-eosin, original magnification ×200). D, Intense Her2 membrane staining (hematoxylin-eosin, original magnification ×200). E, The intraepidermal tumor cells were positive for carcinoembryonic antigen (hematoxylin-eosin, original magnification ×200). F, Cytoplasmic staining for MUC1 (hematoxylin-eosin, original magnification ×200). G, Cytoplasmic staining for cytokeratin 7 (hematoxylin-eosin, original magnification ×200). H, Gross cystic disease fluid protein 15 is positive in EMPD (hematoxylin-eosin, original magnification ×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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Case \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">Author \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">Clinical Diagnosis \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">Size \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">Treatment \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">Chilukuri,<span class="elsevierStyleSup">2</span> 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">67/man \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">Bowen \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<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20 cm \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">Cheek \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">Mohs chemotherapy \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">Cohen,<span class="elsevierStyleSup">3</span> 2004 \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">61/man \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1 cm \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">Right temporal region \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">Photodynamic therapy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \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">Córdoba, 2011 \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">64/woman \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">Bowen/seborrheic 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">5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6 cm \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">Right temporal region \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">Photodynamic therapy \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab185602.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Literature Review of Cases of Extramammary Paget Disease Affecting the Face.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ 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Shindo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1346-8138.2009.00676.x" "Revista" => array:7 [ "tituloSerie" => "J Dermatol" "fecha" => "2009" "volumen" => "36" "paginaInicial" => "457" "paginaFinal" => "461" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19691751" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0010782411000035" "estado" => "S300" "issn" => "00107824" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000004/v1_201304291101/S1578219013000735/v1_201304291101/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/15782190/0000010400000004/v1_201304291101/S1578219013000735/v1_201304291101/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000735?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 9 | 20 |
| 2024 Octubre | 76 | 49 | 125 |
| 2024 Septiembre | 68 | 40 | 108 |
| 2024 Agosto | 117 | 52 | 169 |
| 2024 Julio | 94 | 44 | 138 |
| 2024 Junio | 98 | 33 | 131 |
| 2024 Mayo | 87 | 42 | 129 |
| 2024 Abril | 69 | 22 | 91 |
| 2024 Marzo | 62 | 34 | 96 |
| 2024 Febrero | 83 | 33 | 116 |
| 2024 Enero | 72 | 42 | 114 |
| 2023 Diciembre | 62 | 28 | 90 |
| 2023 Noviembre | 84 | 24 | 108 |
| 2023 Octubre | 64 | 19 | 83 |
| 2023 Septiembre | 94 | 30 | 124 |
| 2023 Agosto | 62 | 26 | 88 |
| 2023 Julio | 67 | 38 | 105 |
| 2023 Junio | 62 | 26 | 88 |
| 2023 Mayo | 82 | 20 | 102 |
| 2023 Abril | 78 | 26 | 104 |
| 2023 Marzo | 57 | 30 | 87 |
| 2023 Febrero | 45 | 25 | 70 |
| 2023 Enero | 39 | 25 | 64 |
| 2022 Diciembre | 63 | 40 | 103 |
| 2022 Noviembre | 40 | 30 | 70 |
| 2022 Octubre | 36 | 26 | 62 |
| 2022 Septiembre | 31 | 35 | 66 |
| 2022 Agosto | 29 | 32 | 61 |
| 2022 Julio | 33 | 30 | 63 |
| 2022 Junio | 35 | 32 | 67 |
| 2022 Mayo | 69 | 36 | 105 |
| 2022 Abril | 58 | 43 | 101 |
| 2022 Marzo | 50 | 60 | 110 |
| 2022 Febrero | 57 | 34 | 91 |
| 2022 Enero | 42 | 49 | 91 |
| 2021 Diciembre | 35 | 35 | 70 |
| 2021 Noviembre | 46 | 43 | 89 |
| 2021 Octubre | 50 | 55 | 105 |
| 2021 Septiembre | 38 | 65 | 103 |
| 2021 Agosto | 37 | 50 | 87 |
| 2021 Julio | 22 | 19 | 41 |
| 2021 Junio | 35 | 34 | 69 |
| 2021 Mayo | 52 | 37 | 89 |
| 2021 Abril | 83 | 41 | 124 |
| 2021 Marzo | 81 | 20 | 101 |
| 2021 Febrero | 69 | 20 | 89 |
| 2021 Enero | 42 | 24 | 66 |
| 2020 Diciembre | 31 | 19 | 50 |
| 2020 Noviembre | 20 | 14 | 34 |
| 2020 Octubre | 14 | 10 | 24 |
| 2020 Septiembre | 23 | 18 | 41 |
| 2020 Agosto | 24 | 23 | 47 |
| 2020 Julio | 23 | 20 | 43 |
| 2020 Junio | 33 | 26 | 59 |
| 2020 Mayo | 27 | 18 | 45 |
| 2020 Abril | 26 | 24 | 50 |
| 2020 Marzo | 31 | 19 | 50 |
| 2020 Febrero | 2 | 15 | 17 |
| 2020 Enero | 4 | 7 | 11 |
| 2019 Diciembre | 6 | 5 | 11 |
| 2019 Noviembre | 4 | 2 | 6 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 0 | 1 | 1 |
| 2019 Agosto | 6 | 4 | 10 |
| 2019 Julio | 4 | 3 | 7 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 4 | 1 | 5 |
| 2019 Abril | 2 | 4 | 6 |
| 2019 Marzo | 2 | 10 | 12 |
| 2019 Febrero | 0 | 4 | 4 |
| 2019 Enero | 4 | 1 | 5 |
| 2018 Diciembre | 0 | 7 | 7 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Febrero | 26 | 2 | 28 |
| 2018 Enero | 44 | 3 | 47 |
| 2017 Diciembre | 38 | 9 | 47 |
| 2017 Noviembre | 36 | 3 | 39 |
| 2017 Octubre | 25 | 5 | 30 |
| 2017 Septiembre | 31 | 5 | 36 |
| 2017 Agosto | 58 | 3 | 61 |
| 2017 Julio | 17 | 3 | 20 |
| 2017 Junio | 41 | 9 | 50 |
| 2017 Mayo | 50 | 3 | 53 |
| 2017 Abril | 47 | 18 | 65 |
| 2017 Marzo | 41 | 6 | 47 |
| 2017 Febrero | 38 | 6 | 44 |
| 2017 Enero | 27 | 9 | 36 |
| 2016 Diciembre | 44 | 18 | 62 |
| 2016 Noviembre | 47 | 14 | 61 |
| 2016 Octubre | 70 | 11 | 81 |
| 2016 Septiembre | 61 | 14 | 75 |
| 2016 Agosto | 29 | 5 | 34 |
| 2016 Julio | 31 | 8 | 39 |
| 2016 Junio | 6 | 5 | 11 |
| 2016 Mayo | 7 | 11 | 18 |
| 2016 Abril | 8 | 6 | 14 |
| 2016 Marzo | 5 | 5 | 10 |
| 2016 Febrero | 4 | 8 | 12 |
| 2016 Enero | 8 | 0 | 8 |
| 2015 Diciembre | 10 | 0 | 10 |
| 2015 Noviembre | 10 | 1 | 11 |
| 2015 Octubre | 10 | 5 | 15 |
| 2015 Septiembre | 11 | 0 | 11 |
| 2015 Agosto | 12 | 1 | 13 |
| 2015 Julio | 48 | 119 | 167 |
| 2015 Junio | 62 | 12 | 74 |
| 2015 Mayo | 65 | 9 | 74 |
| 2015 Abril | 20 | 4 | 24 |
| 2015 Marzo | 29 | 3 | 32 |
| 2015 Febrero | 19 | 6 | 25 |
| 2015 Enero | 22 | 0 | 22 |
| 2014 Diciembre | 29 | 3 | 32 |
| 2014 Noviembre | 21 | 0 | 21 |
| 2014 Octubre | 39 | 4 | 43 |
| 2014 Septiembre | 25 | 5 | 30 |
| 2014 Agosto | 19 | 2 | 21 |
| 2014 Julio | 15 | 7 | 22 |
| 2014 Junio | 40 | 1 | 41 |
| 2014 Mayo | 40 | 6 | 46 |
| 2014 Abril | 44 | 7 | 51 |
| 2014 Marzo | 40 | 9 | 49 |
| 2014 Febrero | 42 | 4 | 46 |
| 2014 Enero | 34 | 10 | 44 |
| 2013 Diciembre | 36 | 7 | 43 |
| 2013 Noviembre | 26 | 7 | 33 |
| 2013 Octubre | 6 | 3 | 9 |
| 2013 Septiembre | 10 | 15 | 25 |
| 2013 Agosto | 21 | 7 | 28 |
| 2013 Julio | 4 | 5 | 9 |
| 2013 Junio | 2 | 7 | 9 |
| 2013 Mayo | 4 | 2 | 6 |
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