Case and research letter
Chondrodermatitis Nodularis Helicis: Successful Treatment with 2% Nitroglycerin Gel
Condrodermatitis nodularis helicis tratada con éxito con nitroglicerina al 2% en gel
O. Yélamos
, J. Dalmau, Ll. Puig
Autor para correspondencia
Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Leído
24097
Vecesse ha leído el artículo
3706
Total PDF
20391
Total HTML
Compartir estadísticas
array:25 [ "pii" => "S1578219013001273" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.07.030" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "aid" => "716" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2012" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:531-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7836 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 6462 "PDF" => 1322 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0001731012004140" "issn" => "00017310" "doi" => "10.1016/j.ad.2012.07.016" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "aid" => "716" "copyright" => "Elsevier España, S.L. y AEDV" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:531-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 12035 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 9395 "PDF" => 2639 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Condrodermatitis <span class="elsevierStyleItalic">nodularis helicis</span> tratada con éxito con nitroglicerina al 2% en gel" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "531" "paginaFinal" => "532" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Chondrodermatitis Nodularis Helicis: Successful Treatment with 2% Nitroglycerin Gel" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2008 "Ancho" => 1500 "Tamanyo" => 547860 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mejoría de la apariencia clínica a los 3 meses de aplicar nitroglicerina al 2% en gel.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "O. Yélamos, J. Dalmau, L. Puig" "autores" => array:3 [ 0 => array:2 [ "nombre" => "O." "apellidos" => "Yélamos" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Dalmau" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Puig" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219013001273" "doi" => "10.1016/j.adengl.2012.07.030" "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/S1578219013001273?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012004140?idApp=UINPBA000044" "url" => "/00017310/0000010400000006/v2_202210080525/S0001731012004140/v2_202210080525/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S1578219013001285" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.06.030" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "aid" => "717" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:533-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2039 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 1535 "PDF" => 456 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and research letter</span>" "titulo" => "Measles as a Reemerging Disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "533" "paginaFinal" => "534" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El sarampión como enfermedad reemergente" ] ] "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" => 1054 "Ancho" => 1583 "Tamanyo" => 225399 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rash consisting of dark red macules and papules on the trunk.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Latorre, M. Blanes" "autores" => array:2 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Latorre" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Blanes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012004152" "doi" => "10.1016/j.ad.2012.06.016" "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/S0001731012004152?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001285?idApp=UINPBA000044" "url" => "/15782190/0000010400000006/v2_202210010908/S1578219013001285/v2_202210010908/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S1578219013001261" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.07.029" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "aid" => "715" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:529-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2975 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 2424 "PDF" => 508 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Vogt-Koyanagi-Harada Disease: A Disorder Unfamiliar to Dermatologists" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "529" "paginaFinal" => "531" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad de Vogt-Koyanagi-Harada. Una entidad poco conocida para el dermatólogo" ] ] "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" => 1417 "Ancho" => 950 "Tamanyo" => 209412 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Diffuse rapid-onset alopecia on the scalp. B, Poliosis of the left eyebrow.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Hernández-Bel, J. Montero, L. Hernández-Bel, A. Torrijos-Aguilar" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Hernández-Bel" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Montero" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Hernández-Bel" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Torrijos-Aguilar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012004139" "doi" => "10.1016/j.ad.2012.07.015" "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/S0001731012004139?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001261?idApp=UINPBA000044" "url" => "/15782190/0000010400000006/v2_202210010908/S1578219013001261/v2_202210010908/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and research letter</span>" "titulo" => "Chondrodermatitis Nodularis Helicis: Successful Treatment with 2% Nitroglycerin Gel" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "531" "paginaFinal" => "532" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "O. Yélamos, J. Dalmau, Ll. Puig" "autores" => array:3 [ 0 => array:4 [ "nombre" => "O." "apellidos" => "Yélamos" "email" => array:1 [ 0 => "oyelamos@santpau.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Dalmau" ] 2 => array:2 [ "nombre" => "Ll." "apellidos" => "Puig" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding Author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Condrodermatitis <span class="elsevierStyleItalic">nodularis helicis</span> tratada con éxito con nitroglicerina al 2% en gel" ] ] "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" => 2008 "Ancho" => 1500 "Tamanyo" => 718762 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous ulcer on the helix of the left ear consistent with chondrodermatitis nodularis helicis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chondrodermatitis nodularis helicis (CNH) is a condition that affects the skin and cartilage of the pinna, manifesting as a single painful nodule on the helix, and less commonly the antihelix. The pathogenesis of CNH is unknown, but has been associated with decreased blood flow caused by prolonged pressure upon the auricular cartilage. Treatment is challenging, with recurrence being common following both conservative treatment and surgery.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of an 83-year-old woman who presented an erythematous nodule with central ulceration on the helix of the left ear; the nodule had appeared 2 years earlier, was extremely painful to touch, and had not responded to treatment with several courses of topical corticosteroids (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) The results of a skin biopsy revealed hyperkeratosis, an acanthotic epidermis with signs of dysplasia, and numerous ectatic capillaries in the upper dermis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In view of these findings, and after malignancy had been ruled out, the patient was diagnosed with CNH and the lesion was treated topically with a 2% nitroglycerin gel once every 12<span class="elsevierStyleHsp" style=""></span>hours for 3 months. An improvement was observed in the appearance of the lesion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and the pain almost completely disappeared. Pain was assessed using a visual analog scale, with 10 corresponding to the worst pain imaginable and 0 to no pain; the patient's score decreased from 8 on the first visit to 1 following 3 months of treatment with nitroglycerin gel. Thus, 4 months after starting treatment (3 months of treatment and 1 of control), a significant improvement in the patient's condition was observed, with no adverse effects.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">CNH is an inflammatory condition characterized by a solitary, firm, well-defined, pink or reddish nodule several millimeters in diameter on the helix or, less commonly, the antihelix, sometimes with central ulceration and crusting. Typically, the lesion is extremely painful to touch, a feature that can facilitate differential diagnosis with other entities, such as actinic keratosis, squamous cell carcinoma, and basal cellular carcinoma.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Histologically, CNH is characterized by a hyperkeratotic stratum corneum with areas of parakeratosis, acanthosis, and in some cases the presence of an ulcer covered by a crust. In more advanced stages, degeneration of the dermis is accompanied by an increase in the number of blood vessels and the presence of perivascular inflammatory infiltrate.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Cartilage degeneration is also observed in biopsies that include cartilage (approximately 70% of all biopsies).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The pathogenesis of the condition is unknown. It is thought that repeated trauma or prolonged pressure, such as that which occurs during sleep at night, may lead to ischemia of the cartilage and the auricular perichondrium, structures that lack the protection of a thick layer of subcutaneous tissue.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Once initiated, ischemia causes necrosis of the cartilage and consequent transepithelial elimination of the degenerated material.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Accordingly, CNH is currently considered a perforating dermatosis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">For this reason several recent reports have described the treatment of CNH treatment with topical nitroglycerin, which has known vasodilatory effects. Flynn et al. described a series of 12 CNH patients who were treated with 2% nitroglycerine gel once every 12<span class="elsevierStyleHsp" style=""></span>hours for 3 months, resulting in cure rates of up to 92%. Complete disappearance of the visible lesion and resolution of pain was observed in 61.5% of patients, while in 30.8% the pain was resolved but some degree of visible lesion persisted.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Topical nitroglycerine acts to relax the arteriolar smooth muscle, reestablishing blood flow and reversing necrosis of the cartilage. The most common adverse effect of topical nitroglycerin for other indications is transient headache, which can affect up to 72% of patients, although in patients with CNH this adverse effect has only been observed in 17% of patients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Other conservative treatments for CNH include the administration of topical or intralesional corticosteroids,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> photodynamic therapy,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and the use of pressure-relieving prostheses,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,8</span></a> with cure rates of 61% to 87%. Surgical techniques, such as cartilage resection with<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> or without<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> conservation of the skin, result in cure rates of up to 83%. However, in the majority of studies it is not specified whether successful treatment involves disappearance of the visible lesion or merely resolution of the pain, and follow-up periods vary greatly, complicating any comparison between different treatments.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In summary, we have presented a new case of CNH that was successfully treated with 2% nitroglycerin gel, a therapy that substantially improved the patient's pain. We consider this treatment to be a useful alternative to currently available therapies, with good tolerance and clinical results and no adverse effects.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Yélamos O, et al. Condrodermatitis <span class="elsevierStyleItalic">nodularis helicis</span> tratada con éxito con nitroglicerina al 2% en gel. Actas Dermosifiliogr. 2013;104:531-2.</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" => 2008 "Ancho" => 1500 "Tamanyo" => 718762 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous ulcer on the helix of the left ear consistent with chondrodermatitis nodularis helicis.</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" => 2008 "Ancho" => 1500 "Tamanyo" => 548667 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Improvement in the clinical appearance of the lesion after 3 months of treatment with 2% nitroglycerin gel.</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" => "Clinical appearance, differential diagnoses and therapeutical options of chondrodermatitis nodularis chronica helicis Winkler" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Wagner" 1 => "J. Liefeith" 2 => "M.M. Sachse" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1610-0387.2011.07601.x" "Revista" => array:6 [ "tituloSerie" => "J Dtsch Dermatol Ges" "fecha" => "2011" "volumen" => "9" "paginaInicial" => "287" "paginaFinal" => "291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21276202" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Topical nitroglycerin: a promising treatment option for chondrodermatitis nodularis helicis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Flynn" 1 => "C. Chisholm" 2 => "R. Grimwood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2010.06.012" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2011" "volumen" => "65" "paginaInicial" => "531" "paginaFinal" => "536" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21529999" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in the understanding of chondrodermatitis nodularis chronica helices: the perichondrial vasculitis theory" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Upile" 1 => "N.N. Patel" 2 => "W. Jerjes" 3 => "N.U. Singh" 4 => "A. Sandison" 5 => "L. Michaels" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1749-4486.2008.01851.x" "Revista" => array:6 [ "tituloSerie" => "Clin Otolaryngol" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "147" "paginaFinal" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19413613" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effective treatment of chondrodermatitis nodularis chronica helicis using a conservative approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Moncrieff" 1 => "E.M. Sassoon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2004.05961.x" "Revista" => array:7 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2004" "volumen" => "150" "paginaInicial" => "892" "paginaFinal" => "894" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15149500" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1542356512009639" "estado" => "S300" "issn" => "15423565" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of chondrodermatitis nodularis chronica helicis with an autoantibody to denatured type <span class="elsevierStyleSmallCaps">ii</span> collagen" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Yoshinaga" 1 => "U. Enomoto" 2 => "N. Fujimoto" 3 => "Y. Ohnishi" 4 => "S. Tajima" 5 => "A. Ishibashi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00015550152384308" "Revista" => array:6 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "2001" "volumen" => "81" "paginaInicial" => "137" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11501653" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intralesional triamcinolone for chondrodermatitis nodularis: a follow-up study of 60 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.H. Cox" 1 => "P.F. Denham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-2133.2002.47047.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2002" "volumen" => "146" "paginaInicial" => "712" "paginaFinal" => "713" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11966717" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chondrodermatitis nodularis helicis successfully treated with photodynamic therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. Gilaberte" 1 => "M.P. Frias" 2 => "J.B. Pérez-Lorenz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2010.265" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2010" "volumen" => "146" "paginaInicial" => "1080" "paginaFinal" => "1082" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956636" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chondrodermatitis nodularis chronica helicis - a conservative therapeutic approach by decompression" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Kuen-Spiegl" 1 => "G. Ratzinger" 2 => "N. Sepp" 3 => "P. Fritsch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1610-0387.2010.07572.x" "Revista" => array:6 [ "tituloSerie" => "J Dtsch Dermatol Ges" "fecha" => "2011" "volumen" => "9" "paginaInicial" => "292" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21091870" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The punch and graft technique: a novel method of surgical treatment for chondrodermatitis nodularis helicis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Rajan" 1 => "J.A. Langtry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2007.08099.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2007" "volumen" => "157" "paginaInicial" => "744" "paginaFinal" => "747" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17672876" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The long-term results of cartilage removal alone for the treatment of chondrodermatitis nodularis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.J. Hudson-Peacock" 1 => "N.H. Cox" 2 => "C.M. Lawrence" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-2133.1999.03113.x" "Revista" => array:7 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1999" "volumen" => "141" "paginaInicial" => "703" "paginaFinal" => "705" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10583120" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1873994611003114" "estado" => "S300" "issn" => "18739946" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000006/v2_202210010908/S1578219013001273/v2_202210010908/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/15782190/0000010400000006/v2_202210010908/S1578219013001273/v2_202210010908/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001273?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 22 | 14 | 36 |
| 2024 Octubre | 3497 | 59 | 3556 |
| 2024 Septiembre | 233 | 67 | 300 |
| 2024 Agosto | 250 | 60 | 310 |
| 2024 Julio | 276 | 51 | 327 |
| 2024 Junio | 246 | 43 | 289 |
| 2024 Mayo | 212 | 51 | 263 |
| 2024 Abril | 166 | 26 | 192 |
| 2024 Marzo | 186 | 37 | 223 |
| 2024 Febrero | 190 | 49 | 239 |
| 2024 Enero | 148 | 40 | 188 |
| 2023 Diciembre | 151 | 20 | 171 |
| 2023 Noviembre | 240 | 45 | 285 |
| 2023 Octubre | 207 | 38 | 245 |
| 2023 Septiembre | 197 | 51 | 248 |
| 2023 Agosto | 182 | 36 | 218 |
| 2023 Julio | 183 | 90 | 273 |
| 2023 Junio | 184 | 47 | 231 |
| 2023 Mayo | 194 | 64 | 258 |
| 2023 Abril | 180 | 32 | 212 |
| 2023 Marzo | 266 | 37 | 303 |
| 2023 Febrero | 173 | 33 | 206 |
| 2023 Enero | 174 | 60 | 234 |
| 2022 Diciembre | 157 | 53 | 210 |
| 2022 Noviembre | 58 | 40 | 98 |
| 2022 Octubre | 56 | 23 | 79 |
| 2022 Septiembre | 52 | 60 | 112 |
| 2022 Agosto | 35 | 35 | 70 |
| 2022 Julio | 49 | 43 | 92 |
| 2022 Junio | 40 | 38 | 78 |
| 2022 Mayo | 261 | 49 | 310 |
| 2022 Abril | 250 | 50 | 300 |
| 2022 Marzo | 254 | 67 | 321 |
| 2022 Febrero | 250 | 32 | 282 |
| 2022 Enero | 234 | 38 | 272 |
| 2021 Diciembre | 213 | 43 | 256 |
| 2021 Noviembre | 197 | 47 | 244 |
| 2021 Octubre | 204 | 66 | 270 |
| 2021 Septiembre | 210 | 44 | 254 |
| 2021 Agosto | 231 | 27 | 258 |
| 2021 Julio | 211 | 31 | 242 |
| 2021 Junio | 210 | 34 | 244 |
| 2021 Mayo | 247 | 43 | 290 |
| 2021 Abril | 623 | 89 | 712 |
| 2021 Marzo | 376 | 58 | 434 |
| 2021 Febrero | 338 | 45 | 383 |
| 2021 Enero | 229 | 40 | 269 |
| 2020 Diciembre | 165 | 30 | 195 |
| 2020 Noviembre | 165 | 18 | 183 |
| 2020 Octubre | 129 | 18 | 147 |
| 2020 Septiembre | 135 | 15 | 150 |
| 2020 Agosto | 143 | 31 | 174 |
| 2020 Julio | 141 | 29 | 170 |
| 2020 Junio | 101 | 26 | 127 |
| 2020 Mayo | 72 | 20 | 92 |
| 2020 Abril | 75 | 25 | 100 |
| 2020 Marzo | 59 | 22 | 81 |
| 2020 Febrero | 3 | 8 | 11 |
| 2020 Enero | 0 | 9 | 9 |
| 2019 Diciembre | 4 | 12 | 16 |
| 2019 Noviembre | 0 | 2 | 2 |
| 2019 Septiembre | 6 | 1 | 7 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 7 | 7 |
| 2019 Junio | 0 | 11 | 11 |
| 2019 Mayo | 3 | 9 | 12 |
| 2019 Abril | 2 | 7 | 9 |
| 2019 Marzo | 0 | 27 | 27 |
| 2019 Febrero | 4 | 0 | 4 |
| 2019 Enero | 1 | 1 | 2 |
| 2018 Diciembre | 0 | 1 | 1 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 5 | 9 | 14 |
| 2018 Agosto | 0 | 12 | 12 |
| 2018 Julio | 0 | 12 | 12 |
| 2018 Junio | 0 | 18 | 18 |
| 2018 Mayo | 0 | 22 | 22 |
| 2018 Abril | 0 | 17 | 17 |
| 2018 Marzo | 15 | 17 | 32 |
| 2018 Febrero | 297 | 33 | 330 |
| 2018 Enero | 350 | 43 | 393 |
| 2017 Diciembre | 222 | 15 | 237 |
| 2017 Noviembre | 175 | 30 | 205 |
| 2017 Octubre | 159 | 27 | 186 |
| 2017 Septiembre | 111 | 26 | 137 |
| 2017 Agosto | 120 | 27 | 147 |
| 2017 Julio | 183 | 37 | 220 |
| 2017 Junio | 267 | 41 | 308 |
| 2017 Mayo | 244 | 21 | 265 |
| 2017 Abril | 128 | 27 | 155 |
| 2017 Marzo | 157 | 26 | 183 |
| 2017 Febrero | 379 | 24 | 403 |
| 2017 Enero | 178 | 26 | 204 |
| 2016 Diciembre | 208 | 27 | 235 |
| 2016 Noviembre | 343 | 36 | 379 |
| 2016 Octubre | 300 | 39 | 339 |
| 2016 Septiembre | 328 | 28 | 356 |
| 2016 Agosto | 316 | 41 | 357 |
| 2016 Julio | 185 | 15 | 200 |
| 2016 Junio | 8 | 8 | 16 |
| 2016 Mayo | 6 | 19 | 25 |
| 2016 Abril | 4 | 31 | 35 |
| 2016 Marzo | 2 | 31 | 33 |
| 2016 Febrero | 6 | 20 | 26 |
| 2016 Enero | 10 | 1 | 11 |
| 2015 Diciembre | 7 | 11 | 18 |
| 2015 Noviembre | 7 | 4 | 11 |
| 2015 Octubre | 24 | 1 | 25 |
| 2015 Septiembre | 10 | 1 | 11 |
| 2015 Agosto | 12 | 3 | 15 |
| 2015 Julio | 130 | 21 | 151 |
| 2015 Junio | 107 | 24 | 131 |
| 2015 Mayo | 119 | 14 | 133 |
| 2015 Abril | 126 | 23 | 149 |
| 2015 Marzo | 132 | 19 | 151 |
| 2015 Febrero | 97 | 18 | 115 |
| 2015 Enero | 82 | 19 | 101 |
| 2014 Diciembre | 83 | 19 | 102 |
| 2014 Noviembre | 67 | 20 | 87 |
| 2014 Octubre | 80 | 27 | 107 |
| 2014 Septiembre | 71 | 15 | 86 |
| 2014 Agosto | 74 | 15 | 89 |
| 2014 Julio | 66 | 16 | 82 |
| 2014 Junio | 84 | 17 | 101 |
| 2014 Mayo | 58 | 27 | 85 |
| 2014 Abril | 58 | 10 | 68 |
| 2014 Marzo | 56 | 18 | 74 |
| 2014 Febrero | 56 | 21 | 77 |
| 2014 Enero | 45 | 28 | 73 |
| 2013 Diciembre | 30 | 5 | 35 |
| 2013 Noviembre | 18 | 10 | 28 |
| 2013 Octubre | 20 | 4 | 24 |
| 2013 Septiembre | 3 | 5 | 8 |
| 2013 Agosto | 5 | 8 | 13 |
| 2013 Julio | 5 | 2 | 7 |
Mostrar todo
