Case and Research Letter
Periungual Bowenoid Papulosis Due to Human Papillomavirus Type 42
Papulosis bowenoide periungueal por virus del papiloma humano 42
M. Gómez Vázquez
, R. Navarra Amayuelas
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Servicio de Dermatología, Hospital Municipal de Badalona, Badalona Serveis Assistencials, Barcelona, Spain
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Gómez Vázquez, R. Navarra Amayuelas" "autores" => array:2 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Gómez Vázquez" "email" => array:1 [ 0 => "mergova@terra.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Navarra Amayuelas" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Municipal de Badalona, Badalona Serveis Assistencials, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papulosis bowenoide periungueal por virus del papiloma humano 42" ] ] "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" => 1328 "Ancho" => 1000 "Tamanyo" => 494243 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hypoplastic epidermis with loss of normal cell architecture, moderate cellular atypia, dyskeratosis, and koilocytes (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 28-year-old man with no relevant past medical history consulted for a progressive, slow-growing exophytic lesion at the edge of the nail of the middle finger on the left hand. The lesion had been present for 2 years. The patient reported that he had had multiple sexual partners up to 6 years earlier.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a red-grayish exophytic periungual lesion measuring 0.7<span class="elsevierStyleHsp" style=""></span>cm in diameter with a hyperkeratotic surface (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Histopathologic examination showed a hyperplastic epidermis with loss of normal cell architecture, moderate cellular atypia, dyskeratosis, and koilocytes in the epidermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Overexpression of the tumor suppressor protein p16 was also observed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Based on a diagnosis of extragenital bowenoid papulosis, the patient was re-questioned, but he reported that neither he nor his current partner had had genital or anal warts. Lymphocyte counts (including CD4 and CD8 counts) were normal and serologic testing for human immunodeficiency virus (HIV) was negative. Human papillomavirus (HPV) DNA testing using the hybrid capture assay detected HPV 42. It was decided to excise the entire lesion and schedule periodic follow-up visits for the patient and his partner. The patient was asymptomatic a year after diagnosis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The term <span class="elsevierStyleItalic">bowenoid papulosis</span> was introduced to describe multiple wart-like papules in the genital region that are histologically similar to Bowen disease and clinically similar to genital warts. The condition typically affects young, sexually active individuals and mainly involves the genital, crural, and perianal regions. However, there have also been reports of extragenital bowenoid papulosis with or without concomitant genital lesions in both immunocompetent and immunodeficient patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Bowenoid papulosis is associated with HPV infection. While there is a close link with HPV 16 infection,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> types 18, 31-35, 39, 42, 48, and 51-54 have also been implicated.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> HPV 16, 18, and 33 are considered to have the greatest oncogenic potential.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Bowenoid papulosis is considered to be a squamous cell carcinoma in situ and has an estimated risk of malignant transformation of 2.6%.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The oncogenic mechanism is probably initiated by HPV-induced genetic changes in infected cells. High-risk serotypes produce HPV oncoproteins E6 and E7, which are capable of inactivating the Rb and p53 tumor suppressor proteins, respectively, giving rise to uncontrolled cell proliferation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> HPV has been detected in bowenoid papulosis lesions and adjacent healthy skin, indicating that HPV infection is a necessary but not sufficient factor in the development of bowenoid papulosis. Other alterations, such as additional genetic mutations in the host cell, may be necessary.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Bowen papulosis is histologically similar to Bowen disease, but exhibits more focal and less intense changes.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,6</span></a> To distinguish between the 2 entities, it is always necessary to correlate clinical and histologic findings.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The prevalence of Bowenoid papulosis is unknown, as the lesions are commonly confused with other wart-like lesions and are frequently destroyed without histological examination.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Since the lesions tend to recur and have malignant potential, patients and their sexual partners should be referred for periodic follow-up and an immunological study in the case of persistent or recurrent lesions.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The clinical course is variable, with some lesions progressing to chronic or malignant forms and others spontaneously regressing. Conservative treatment involving destruction of the lesions by simple excision, electrocoagulation, or cryosurgery is the most effective therapeutic approach.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Bowenoid papulosis generally occurs with concomitant genital lesions or in patients with a history of HPV-induced lesions<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).Transmission is believed to occur through direct contact, autoinoculation, or fomites.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,7,9</span></a> These transmission mechanisms would explain the involvement of different parts of the body. Reports in the literature describe lesions affecting the neck, the abdomen, the shoulder, the chin, and the periungual area, among others.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–10</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">We have reported a new case of bowenoid papulosis affecting the periungual area of a finger in a patient with no past or present history of genital lesions. Two similar cases of extragenital bowenoid papulosis have been reported in the literature. One of the patients had bowenoid papulosis lesions in the perianal area that were detected on diagnosis of the nail lesion<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and the other patient had HIV infection.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We believe that lesions in young sexually active patients should be examined histologically, even when they are located at a distance from the genital region. The possibility of immunosuppressive conditions should be investigated, as should the presence of genital lesions in the patients and their partners.</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: Gómez Vázquez M, Navarra Amayuelas R. Papulosis bowenoide periungueal por virus del papiloma humano 42. Actas Dermosifiliogr. 2013;104:932–934.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 394 "Ancho" => 866 "Tamanyo" => 46787 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Red-grayish exophytic periungual lesion with a hyperkeratotic surface.</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" => 1328 "Ancho" => 1000 "Tamanyo" => 494243 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hypoplastic epidermis with loss of normal cell architecture, moderate cellular atypia, dyskeratosis, and koilocytes (hematoxylin-eosin, original magnification ×40).</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" => 979 "Ancho" => 1300 "Tamanyo" => 345751 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Overexpression of tumor suppressor protein p16.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: HIV, human immunodeficiency virus; HPV, human papillomavirus.</p>" "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">Cases \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">Immunodeficiency \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">Site \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">HPV Detected \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">Transmission \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">Genital Lesions \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">Bart<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> \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 known \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">Chin \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 tested \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="" 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">Not known \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">Grussendorg-Conen<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> \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="" 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">Neck \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">HPV 16 \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="" 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">No \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">Rüdlinger et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> \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">No \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">Periungual \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">HPV 35 \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">Direct contact \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">Yes \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">Grob et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> \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">No \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">Neck \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">HPV 16 \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">Razor \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">No \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">Johnson et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> \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">No \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">Neck \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">42 \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">Razor \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">No \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">Fader et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> \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">HIV \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">Neck \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">HPV 31, 33, 35 \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">Razor \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">Yes (in the past) \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">Baron et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> \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="" 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">Neck \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">18 \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="" 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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Purnell et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> \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">Idiopathic CD4<span class="elsevierStyleSup">+</span> lymphocytopenia \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">Finger \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">18 \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="" 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">No \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">Papadopoulos et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> \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">NoHIV \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">ShoulderAbdomen \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, 1, 42, 43, 44Not identified \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="" 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">NoNo \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">Oh et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> \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">No \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">Toe webs \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">16 \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">Tinea pedis \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">No \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">Our 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">No \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">Periungual \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">42 \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="" 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">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab430514.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A Selection of Published Cases of Extragenital Bowenoid Papulosis.</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" => "Isolated extragenital bowenoid papulosis of the neck" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.M. Johnson" 1 => "A. Saluja" 2 => "D. Fader" 3 => "D. Blum" 4 => "J. Cotton" 5 => "T.S. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1999" "volumen" => "41" "paginaInicial" => "867" "paginaFinal" => "870" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10534673" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolated extragenital HPV-thirties-group-positive bowenoid papulosis in an AIDS patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.J. Fader" 1 => "M.H. Stoler" 2 => "T.F. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 6 | 17 |
| 2024 Octubre | 96 | 64 | 160 |
| 2024 Septiembre | 100 | 41 | 141 |
| 2024 Agosto | 130 | 51 | 181 |
| 2024 Julio | 106 | 56 | 162 |
| 2024 Junio | 143 | 40 | 183 |
| 2024 Mayo | 116 | 38 | 154 |
| 2024 Abril | 100 | 29 | 129 |
| 2024 Marzo | 117 | 23 | 140 |
| 2024 Febrero | 95 | 45 | 140 |
| 2024 Enero | 92 | 30 | 122 |
| 2023 Diciembre | 83 | 16 | 99 |
| 2023 Noviembre | 118 | 33 | 151 |
| 2023 Octubre | 116 | 15 | 131 |
| 2023 Septiembre | 113 | 28 | 141 |
| 2023 Agosto | 75 | 31 | 106 |
| 2023 Julio | 97 | 38 | 135 |
| 2023 Junio | 83 | 22 | 105 |
| 2023 Mayo | 110 | 32 | 142 |
| 2023 Abril | 95 | 22 | 117 |
| 2023 Marzo | 67 | 50 | 117 |
| 2023 Febrero | 75 | 22 | 97 |
| 2023 Enero | 59 | 36 | 95 |
| 2022 Diciembre | 83 | 42 | 125 |
| 2022 Noviembre | 57 | 28 | 85 |
| 2022 Octubre | 48 | 27 | 75 |
| 2022 Septiembre | 45 | 50 | 95 |
| 2022 Agosto | 35 | 19 | 54 |
| 2022 Julio | 32 | 41 | 73 |
| 2022 Junio | 32 | 36 | 68 |
| 2022 Mayo | 69 | 40 | 109 |
| 2022 Abril | 67 | 29 | 96 |
| 2022 Marzo | 67 | 46 | 113 |
| 2022 Febrero | 52 | 31 | 83 |
| 2022 Enero | 55 | 38 | 93 |
| 2021 Diciembre | 34 | 19 | 53 |
| 2021 Noviembre | 62 | 54 | 116 |
| 2021 Octubre | 47 | 43 | 90 |
| 2021 Septiembre | 39 | 47 | 86 |
| 2021 Agosto | 63 | 29 | 92 |
| 2021 Julio | 53 | 32 | 85 |
| 2021 Junio | 51 | 43 | 94 |
| 2021 Mayo | 37 | 28 | 65 |
| 2021 Abril | 95 | 85 | 180 |
| 2021 Marzo | 58 | 47 | 105 |
| 2021 Febrero | 48 | 25 | 73 |
| 2021 Enero | 51 | 18 | 69 |
| 2020 Diciembre | 31 | 20 | 51 |
| 2020 Noviembre | 42 | 21 | 63 |
| 2020 Octubre | 42 | 18 | 60 |
| 2020 Septiembre | 32 | 15 | 47 |
| 2020 Agosto | 34 | 18 | 52 |
| 2020 Julio | 39 | 17 | 56 |
| 2020 Junio | 63 | 34 | 97 |
| 2020 Mayo | 43 | 25 | 68 |
| 2020 Abril | 30 | 35 | 65 |
| 2020 Marzo | 35 | 26 | 61 |
| 2020 Febrero | 4 | 16 | 20 |
| 2020 Enero | 0 | 18 | 18 |
| 2019 Diciembre | 0 | 16 | 16 |
| 2019 Noviembre | 0 | 18 | 18 |
| 2019 Octubre | 0 | 14 | 14 |
| 2019 Septiembre | 0 | 15 | 15 |
| 2019 Agosto | 0 | 9 | 9 |
| 2019 Julio | 0 | 20 | 20 |
| 2019 Junio | 0 | 25 | 25 |
| 2019 Mayo | 0 | 18 | 18 |
| 2019 Abril | 0 | 31 | 31 |
| 2019 Marzo | 0 | 21 | 21 |
| 2019 Febrero | 2 | 13 | 15 |
| 2019 Enero | 0 | 19 | 19 |
| 2018 Diciembre | 2 | 6 | 8 |
| 2018 Noviembre | 1 | 3 | 4 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Junio | 0 | 2 | 2 |
| 2018 Mayo | 0 | 6 | 6 |
| 2018 Abril | 0 | 6 | 6 |
| 2018 Marzo | 7 | 2 | 9 |
| 2018 Febrero | 46 | 9 | 55 |
| 2018 Enero | 42 | 12 | 54 |
| 2017 Diciembre | 42 | 9 | 51 |
| 2017 Noviembre | 49 | 4 | 53 |
| 2017 Octubre | 59 | 4 | 63 |
| 2017 Septiembre | 48 | 11 | 59 |
| 2017 Agosto | 55 | 6 | 61 |
| 2017 Julio | 33 | 10 | 43 |
| 2017 Junio | 59 | 15 | 74 |
| 2017 Mayo | 44 | 15 | 59 |
| 2017 Abril | 31 | 11 | 42 |
| 2017 Marzo | 34 | 10 | 44 |
| 2017 Febrero | 51 | 8 | 59 |
| 2017 Enero | 34 | 6 | 40 |
| 2016 Diciembre | 48 | 17 | 65 |
| 2016 Noviembre | 96 | 17 | 113 |
| 2016 Octubre | 104 | 15 | 119 |
| 2016 Septiembre | 168 | 11 | 179 |
| 2016 Agosto | 67 | 11 | 78 |
| 2016 Julio | 39 | 11 | 50 |
| 2016 Junio | 6 | 11 | 17 |
| 2016 Mayo | 7 | 6 | 13 |
| 2016 Abril | 5 | 5 | 10 |
| 2016 Marzo | 10 | 3 | 13 |
| 2016 Febrero | 16 | 1 | 17 |
| 2016 Enero | 5 | 1 | 6 |
| 2015 Diciembre | 10 | 0 | 10 |
| 2015 Noviembre | 13 | 3 | 16 |
| 2015 Octubre | 8 | 1 | 9 |
| 2015 Septiembre | 9 | 3 | 12 |
| 2015 Agosto | 7 | 1 | 8 |
| 2015 Julio | 46 | 1 | 47 |
| 2015 Junio | 33 | 11 | 44 |
| 2015 Mayo | 44 | 16 | 60 |
| 2015 Abril | 35 | 7 | 42 |
| 2015 Marzo | 25 | 8 | 33 |
| 2015 Febrero | 34 | 6 | 40 |
| 2015 Enero | 50 | 7 | 57 |
| 2014 Diciembre | 36 | 5 | 41 |
| 2014 Noviembre | 36 | 3 | 39 |
| 2014 Octubre | 40 | 3 | 43 |
| 2014 Septiembre | 36 | 1 | 37 |
| 2014 Agosto | 37 | 5 | 42 |
| 2014 Julio | 36 | 7 | 43 |
| 2014 Junio | 55 | 6 | 61 |
| 2014 Mayo | 46 | 10 | 56 |
| 2014 Abril | 35 | 4 | 39 |
| 2014 Marzo | 49 | 7 | 56 |
| 2014 Febrero | 28 | 4 | 32 |
| 2014 Enero | 25 | 9 | 34 |
| 2013 Diciembre | 17 | 4 | 21 |
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