Case Report
Acquired Perforating Dermatosis: A Report of 8 Cases
Dermatosis perforante adquirida: presentación de 8 casos
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Serie de 5 casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "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" => 770 "Ancho" => 1028 "Tamanyo" => 151068 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hidradenitis suppurativa: Bilateral axillary involvement. Results for patients 1 (above) and 2 (below) mentioned in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. A, Before treatment. B, At 8 weeks’ follow-up.Treatment response was satisfactory in patient 1. Considerable reduction of inflammatory lesions and decreased signs of disease activity were observed in patient 2.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Andino Navarrete, A. Hasson Nisis, J. Parra Cares" "autores" => array:3 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Andino Navarrete" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Hasson Nisis" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Parra Cares" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013004055" "doi" => "10.1016/j.ad.2013.10.016" "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/S0001731013004055?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001498?idApp=UINPBA000044" "url" => "/15782190/0000010500000006/v1_201406280124/S1578219014001498/v1_201406280124/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Acquired Perforating Dermatosis: A Report of 8 Cases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e39" "paginaFinal" => "e43" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. González-Lara, S. Gómez-Bernal, F. Vázquez-López, B. Vivanco-Allende" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "González-Lara" "email" => array:1 [ 0 => "leiregonzalezlara@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Gómez-Bernal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Vázquez-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "B." "apellidos" => "Vivanco-Allende" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatosis perforante adquirida: presentación de 8 casos" ] ] "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" => 1159 "Ancho" => 930 "Tamanyo" => 259911 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Multiple papules and plaques on the dorsal and lumbar region of the back in patient 6; the lesions have a central hyperkeratotic plug and an erythematous halo.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The perforating dermatoses are a heterogeneous group of diseases characterized by the transepidermal elimination of one or more components of the skin. Four types are traditionally recognized: elastosis perforans serpiginosum, perforating folliculitis, Kyrle disease, and reactive perforating collagenosis (RPC). Two variants of RPC have been described: a rare hereditary form that presents in childhood and a more common acquired form that appears in adult life and mainly affects diabetic patients with chronic renal failure (CRF).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Over the years, there has been a degree of confusion regarding the terminology. At the present time, the majority of authors use the term <span class="elsevierStyleItalic">reactive perforating collagenosis</span> for the hereditary form, while the term <span class="elsevierStyleItalic">acquired perforating dermatosis</span> (APD), proposed by Rapini et al., is preferred for the adult form and for any perforating disease that is clinically and histologically similar to the primary disease but that is associated with a systemic disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">APD is a rare disease. The majority of descriptions are in the form of isolated case reports; a few case series exist.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> We present a series of 8 cases.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Descriptions</span><p id="par0015" class="elsevierStylePara elsevierViewall">We present 8 cases of APD in 3 men and 5 women with a mean age of 73 years (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The time from the onset of symptoms to diagnosis varied between 2 weeks and 4 months, with a mean of 5.5 weeks.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Clinically, patients presented multiple umbilicated papules that were highly pruritic and had a firmly adherent central keratotic plug (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The most common sites were the back and the lower limbs. Histopathology study, performed in all patients using hematoxylin-eosin, Masson trichromic, and Verhoeff stains, revealed epidermal hyperplasia with a cup-shaped central depression covered by keratin and cell remnants, as well as the transepidermal elimination of verticalized collagen fibers (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>, A and<span class="elsevierStyleHsp" style=""></span>B). The elimination of elastic fibers was not detected in any of the patients. All patients satisfied the diagnostic criteria proposed by Faver: umbilicated papules or nodules with an adherent center of keratotic appearance, histopathological identification of the elimination of basophilic collagen, and onset of the skin lesions after 18 years of age.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Diabetes mellitus (DM), with or without CRF, was the most common association and was present in 7 cases. Three patients had liver disease (fatty liver, alcoholic cirrhosis, and hepatitis C virus-induced chronic liver disease).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">All the patients with DM and/or CRF presented a deterioration of renal function coinciding with the onset of the skin lesions. The increase in the creatinine level was of 0.36-1.90<span class="elsevierStyleHsp" style=""></span>mg/dL, with a mean elevation of 1.14<span class="elsevierStyleHsp" style=""></span>mg/dL with respect to baseline levels, and the levels returned to baseline in the follow-up laboratory tests at 1 to 2 months. The majority of our cases were treated with topical corticosteroids and antihistamines; 1 patient received narrowband UV-B and another received topical antibiotics and copper sulfate poultices. The lesions resolved in 1 to 4 months (mean, 2.6 months), leaving residual hyperpigmented scars. Follow-up at 1 year revealed no new lesions.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">The term <span class="elsevierStyleItalic">acquired perforating dermatosis</span>, introduced in 1989 by Rapini et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> refers to the perforating dermatoses that appear in adults and are associated with systemic diseases (mainly DM and CRF). Publications prior to the study by Rapini et al. used other terms to refer to this disease (Kyrle-like lesions, perforating folliculitis of hemodialysis, Kyrle disease in patients with CRF, uremic follicular hyperkeratosis, perforating pseudoxanthoma elasticum associated with CRF and hemodialysis, elastosis perforans serpiginosum, and reactive perforating collagenosis of DM and CRF<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a>), exacerbating the confusion that has surrounded this disease up to now. APD presents as a rash of umbilicated papules with a central keratotic cap and is associated with widespread pruritus. The most common sites are the trunk and limbs, usually in areas accessible to scratching and sometimes show a linear distribution, as manifestations of the Koebner phenomenon.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Histopathology reveals findings of any of the 4 classic perforating diseases, and more than 1 pattern may be observed in a single patient.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a> APD has been reported in association with numerous systemic diseases (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). A typical case would be a patient with DM and CRF of diabetic origin. The DM is usually long-standing, and micro- and macroangiopathic complications may be present.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,10</span></a> But other causes of CRF, such as human immunodeficiency virus infection,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> immunoglobulin A nephropathy, glomerulonephritis, and heroin abuse have also been described.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> APD can develop during the course of various liver diseases without accompanying DM and/or CRF, as occurred in case 7 in our series. These liver diseases include viral hepatitis (hepatitis A, B, or C viruses), fatty liver,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> cirrhosis, hepatocellular carcinoma, and liver metastases.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Our 7 patients with DM and/or CRF presented a deterioration of renal function coinciding with the onset of the skin lesions. In a review of the literature we found no data to suggest that creatinine levels can play a role in the onset of APD or of uremic pruritus. The temporal coincidence of the elevation of the creatinine levels and the onset of the APD lesions observed in our patients would suggest that there may be a relationship between the acute deterioration of renal function and APD in patients with CRF and/or DM. However, because of the small number of patients in our series, we cannot establish a firm causal relationship between the acute deterioration of renal function and the onset of APD. Studies with a larger number of patients would be necessary to confirm this association.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The pathogenesis of APD is not fully understood. The most widely accepted hypothesis involves pruritus as the principal trigger, as it is present in all cases. Scratching produces microtrauma that leads to changes in the collagen fibers of the papillary dermis, facilitating their transepidermal elimination as the final stage.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a> Numerous skin or systemic diseases that provoke pruritus and scratching can therefore lead to the onset of APD in patients with underlying metabolic changes.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Some publications have related the onset of APD to dialysis,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> but it has subsequently been shown that APD can occur both before and after dialysis. In addition, APD can appear in patients on hemodialysis, peritoneal dialysis, or even in patients without dialysis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,10</span></a> Although an improvement in APD lesions has been reported after kidney transplant, APD lesions have developed after transplant in some patients, as occurred in cases 1 and 5 in our series, coinciding with a deterioration in graft function.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Numerous treatments for APD have been described, aimed mainly at controlling the pruritus.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most widely used are emollients, keratolytics, topical retinoids, topical, oral, or intradermal corticosteroids, phototherapy (broadband and narrowband UV-B), photochemotherapy (psoralen–UV-A),<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>and allopurinol.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Other options, including oral retinoids, doxycycline, rifampicin, amitriptyline, surgical debridement, electrical nerve stimulation, photodynamic therapy, and topical cantharidin, have produced satisfactory results in isolated cases.</p><p id="par0055" class="elsevierStylePara elsevierViewall">APD develops in patients with widespread pruritus and systemic diseases, the most common association being with DM and CRF. We present a series of 8 cases of APD, 7 with DM, of whom 5 also presented CRF, and a single patient with cirrhosis of the liver. A deterioration of renal function was observed in all the patients with DM and/or CRF, coinciding with the onset of APD. In patients with DM and/or CRF of diabetic origin, acute deterioration of renal function may be implicated in the onset of APD. Further studies are necessary to confirm this relationship.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical Disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they followed their hospital's regulations regarding the publication of patient information and that written informed consent for voluntary participation was obtained for all patients.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres349105" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec330771" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres349106" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec330772" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Descriptions" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec330771" "palabras" => array:4 [ 0 => "Acquired perforating dermatosis" 1 => "Transepidermal elimination" 2 => "Chronic renal failure" 3 => "Pruritus" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec330772" "palabras" => array:4 [ 0 => "Dermatosis perforante adquirida" 1 => "Eliminación transepidérmica" 2 => "Insuficiencia renal crónica" 3 => "Prurito" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Acquired perforating dermatosis (APD) is an uncommon disease characterized by lesions exhibiting transepidermal elimination of collagen or elastic fibers. APD affects adults and is associated with systemic diseases, mainly diabetes mellitus and renal failure.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present 8 cases of APD. Seven patients had concomitant diabetes mellitus with or without chronic renal failure, and 1 had alcoholic cirrhosis. In the patients with chronic renal failure, the onset of APD coincided with transient worsening of renal function. The mean increase in creatinine concentrations above baseline was 1.14<span class="elsevierStyleHsp" style=""></span>mg/dL. Acute deterioration of renal function may be involved in APD. Further studies are needed to investigate this association.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La dermatosis perforante adquirida (DPA) es una enfermedad infrecuente caracterizada por la aparición de lesiones que presentan eliminación transepidérmica de colágeno o fibras elásticas. Afecta a adultos y se asocia a enfermedades sistémicas, principalmente diabetes mellitus e insuficiencia renal.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Presentamos 8 casos de DPA, 7 con diabetes mellitus e insuficiencia renal crónica (IRC) y uno con cirrosis alcohólica. Los pacientes con IRC tuvieron un empeoramiento transitorio de la misma coincidiendo con la aparición de la DPA. La creatinina se elevó de media 1,14<span class="elsevierStyleHsp" style=""></span>mg/dl. El deterioro agudo de la función renal podría estar implicado en la DPA. Se necesitan más estudios para confirmar esta relación.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: González-Lara L, Gómez-Bernal S, Vázquez-López F, Vivanco-Allende B. Dermatosis perforante adquirida: presentación de 8 casos. Actas Dermosifiliogr. 2014;105:e39–e43.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1159 "Ancho" => 930 "Tamanyo" => 259911 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Multiple papules and plaques on the dorsal and lumbar region of the back in patient 6; the lesions have a central hyperkeratotic plug and an erythematous halo.</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" => 697 "Ancho" => 930 "Tamanyo" => 112543 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Larger lesions than in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>, in this case on the back of patient 8.</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" => 612 "Ancho" => 1394 "Tamanyo" => 303754 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A, Cup-shaped central depression covered by keratin and cell remnants (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10). B, Transepidermal elimination of verticalized collagen fibers (Masson trichromic stain, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20).</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: EPO, erythropoietin; GC, glucocorticoid; HCV, hepatitis C virus; IDDM2, insulin-dependent type 2 diabetes mellitus; NB–UV-B, narrowband UV-B; OAH, oral antihistamines; TIA, transient ischemic attack.</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">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">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">Age \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">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">Time Since Onset, wk \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">Hospitalized/Uremic Pruritus \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">Treatment \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">Time to Healing, mo \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">Associated Diseases \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Creatinine</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">Drug History \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-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Baseline \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">APD \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></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">F \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">74 \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">Back (dorsolumbar) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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/Yes \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">Topical GCOAH \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">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">IDDM2 (renal disease, retinopathy, peripheral arterial disease, and severe aortic stenosis), kidney transplant (chronic renal disease of the graft) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.78 \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">2.99 \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">InsulinCiclosporinMycophenolate mofetilAcenocoumarolFurosemideBisoprolol \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">F \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">84 \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">Back (dorsal) and shoulders \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">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">Yes/Yes \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">Topical GCOAH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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">IDDM2 (renal disease, retinopathy, peripheral arterial disease, and vascular dementia) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.90 \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">3.21 \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">InsulinAripiprazoleClopidogrelMirtazapineAtorvastatin \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">M \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">69 \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">Lower limbs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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/Yes \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">Topical GCOAH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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">IDDM2 (renal disease, retinopathy, TIA, coronary heart disease, peripheral arterial disease) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.90 \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">3.80 \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">InsulinMetforminClopidogrelAtorvastatin \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">4 \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">M \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 \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">Back (dorsolumbar), lower legs and knees \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \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/Yes \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">NB–UV-B \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">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">IDDM2 (renal disease, peripheral arterial disease), HCV-induced cirrhosis, hypertensive cardiopathy, hyperuricemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.81 \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">InsulinGlimepirideAllopurinolVerapamil \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">5 \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">F \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">73 \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">Back (lumbar) and buttocks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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/Yes \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">Topical GCOAHPetrolatum jelly \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">Pending \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">Hypertension, hypertensive cardiopathy, IDDM (retinopathy, renal disease)Kidney transplant (chronic renal disease of the graft) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.78 \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">2.99 \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">DialysisInsulinEPOMycophenolate mofetilCiclosporinDigoxinFurosemideAcenocoumarol \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">6 \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">F \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">84 \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">Back (dorsolumbar) \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">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">Yes/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">Topical GC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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">IDDM2, TIA, fatty liver \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.71 \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">InsulinValsartanDigoxinWarfarin \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">7 \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">M \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">56 \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">Back (dorsolumbar) and upper and lower limbs \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 \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/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">Topical GCOAH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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">Alcoholic cirrhosis, dilated cardiomyopathy \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">0.84 \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">0.87 \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">WarfarinCarvedilolSpironolactoneSildenafil \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">8 \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">F \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">79 \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">Back (dorsal), abdomen, and knees \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">No/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">Copper sulfate poulticesFusidic acid \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">Pending \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">IDDMHypertensionHCV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.34 \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">CarvedilolValsartanWarfarinVitamin B \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab521015.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Case Descriptions.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "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=""><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">Tumors \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">Acute leukemia, Hodgkin lymphoma, carcinoma of the prostate, nasopharyngeal carcinoma, adenocarcinoma of the ampoule of Vater, hepatocellular carcinoma, liver metastases, carcinoma of the colon, malignant histiocytosis, papillary carcinoma of the thyroid, and adenocarcinoma of the pancreas \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">Infectious diseases \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">AIDS and pulmonary aspergillosis \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">Liver disease \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">Viral hepatitis (A, B, and C), fatty liver, cirrhosis, and sclerosing cholangitis \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">Thyroid disease \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">Hyperparathyroidism, euthyroid patient syndrome, and hypothyroidism \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">Dermatoses \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">Scabies, atopic dermatitis, dermatomyositis, lupus vulgaris, neurodermatitis, insect bite, and herpes zoster \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">Other diseases \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">Pulmonary fibrosis, recurrent pleuritis, Poland syndrome, polymorphous eruption of pregnancy, drug-induced (sorafenib, erlotinib, gefitinib), and postcurettage \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab521016.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Associated Systemic Diseases.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatosis perforante adquirida: tratamiento con alopurinol" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 29 | 15 | 44 |
| 2024 Octubre | 281 | 64 | 345 |
| 2024 Septiembre | 364 | 55 | 419 |
| 2024 Agosto | 444 | 84 | 528 |
| 2024 Julio | 433 | 59 | 492 |
| 2024 Junio | 331 | 68 | 399 |
| 2024 Mayo | 336 | 49 | 385 |
| 2024 Abril | 249 | 42 | 291 |
| 2024 Marzo | 286 | 54 | 340 |
| 2024 Febrero | 300 | 47 | 347 |
| 2024 Enero | 251 | 38 | 289 |
| 2023 Diciembre | 205 | 36 | 241 |
| 2023 Noviembre | 268 | 34 | 302 |
| 2023 Octubre | 183 | 39 | 222 |
| 2023 Septiembre | 236 | 35 | 271 |
| 2023 Agosto | 165 | 23 | 188 |
| 2023 Julio | 210 | 61 | 271 |
| 2023 Junio | 228 | 35 | 263 |
| 2023 Mayo | 191 | 55 | 246 |
| 2023 Abril | 223 | 36 | 259 |
| 2023 Marzo | 164 | 55 | 219 |
| 2023 Febrero | 166 | 29 | 195 |
| 2023 Enero | 160 | 38 | 198 |
| 2022 Diciembre | 152 | 48 | 200 |
| 2022 Noviembre | 71 | 36 | 107 |
| 2022 Octubre | 63 | 25 | 88 |
| 2022 Septiembre | 97 | 50 | 147 |
| 2022 Agosto | 98 | 34 | 132 |
| 2022 Julio | 73 | 55 | 128 |
| 2022 Junio | 102 | 45 | 147 |
| 2022 Mayo | 291 | 50 | 341 |
| 2022 Abril | 298 | 50 | 348 |
| 2022 Marzo | 309 | 55 | 364 |
| 2022 Febrero | 249 | 49 | 298 |
| 2022 Enero | 306 | 55 | 361 |
| 2021 Diciembre | 207 | 54 | 261 |
| 2021 Noviembre | 220 | 63 | 283 |
| 2021 Octubre | 224 | 62 | 286 |
| 2021 Septiembre | 164 | 50 | 214 |
| 2021 Agosto | 170 | 51 | 221 |
| 2021 Julio | 135 | 52 | 187 |
| 2021 Junio | 228 | 33 | 261 |
| 2021 Mayo | 215 | 45 | 260 |
| 2021 Abril | 363 | 100 | 463 |
| 2021 Marzo | 180 | 21 | 201 |
| 2021 Febrero | 137 | 25 | 162 |
| 2021 Enero | 104 | 23 | 127 |
| 2020 Diciembre | 73 | 20 | 93 |
| 2020 Noviembre | 52 | 22 | 74 |
| 2020 Octubre | 44 | 31 | 75 |
| 2020 Septiembre | 53 | 13 | 66 |
| 2020 Agosto | 28 | 24 | 52 |
| 2020 Julio | 38 | 20 | 58 |
| 2020 Junio | 43 | 33 | 76 |
| 2020 Mayo | 41 | 42 | 83 |
| 2020 Abril | 42 | 24 | 66 |
| 2020 Marzo | 35 | 31 | 66 |
| 2020 Febrero | 6 | 14 | 20 |
| 2020 Enero | 4 | 8 | 12 |
| 2019 Diciembre | 8 | 12 | 20 |
| 2019 Noviembre | 4 | 7 | 11 |
| 2019 Octubre | 0 | 14 | 14 |
| 2019 Septiembre | 4 | 17 | 21 |
| 2019 Agosto | 4 | 10 | 14 |
| 2019 Julio | 4 | 14 | 18 |
| 2019 Junio | 7 | 12 | 19 |
| 2019 Mayo | 4 | 36 | 40 |
| 2019 Abril | 2 | 24 | 26 |
| 2019 Marzo | 4 | 18 | 22 |
| 2019 Febrero | 2 | 12 | 14 |
| 2019 Enero | 2 | 9 | 11 |
| 2018 Diciembre | 4 | 10 | 14 |
| 2018 Noviembre | 2 | 5 | 7 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Julio | 0 | 2 | 2 |
| 2018 Junio | 0 | 6 | 6 |
| 2018 Mayo | 0 | 17 | 17 |
| 2018 Abril | 0 | 14 | 14 |
| 2018 Marzo | 1 | 5 | 6 |
| 2018 Febrero | 54 | 9 | 63 |
| 2018 Enero | 73 | 7 | 80 |
| 2017 Diciembre | 123 | 15 | 138 |
| 2017 Noviembre | 79 | 11 | 90 |
| 2017 Octubre | 81 | 10 | 91 |
| 2017 Septiembre | 65 | 9 | 74 |
| 2017 Agosto | 53 | 14 | 67 |
| 2017 Julio | 57 | 18 | 75 |
| 2017 Junio | 71 | 25 | 96 |
| 2017 Mayo | 130 | 26 | 156 |
| 2017 Abril | 79 | 12 | 91 |
| 2017 Marzo | 89 | 20 | 109 |
| 2017 Febrero | 155 | 10 | 165 |
| 2017 Enero | 64 | 18 | 82 |
| 2016 Diciembre | 76 | 21 | 97 |
| 2016 Noviembre | 130 | 10 | 140 |
| 2016 Octubre | 121 | 43 | 164 |
| 2016 Septiembre | 156 | 25 | 181 |
| 2016 Agosto | 114 | 8 | 122 |
| 2016 Julio | 38 | 13 | 51 |
| 2016 Junio | 8 | 2 | 10 |
| 2016 Mayo | 5 | 1 | 6 |
| 2016 Abril | 5 | 2 | 7 |
| 2016 Marzo | 3 | 1 | 4 |
| 2016 Febrero | 8 | 2 | 10 |
| 2016 Enero | 14 | 9 | 23 |
| 2015 Diciembre | 12 | 3 | 15 |
| 2015 Noviembre | 14 | 3 | 17 |
| 2015 Octubre | 11 | 3 | 14 |
| 2015 Septiembre | 14 | 5 | 19 |
| 2015 Agosto | 17 | 1 | 18 |
| 2015 Julio | 136 | 7 | 143 |
| 2015 Junio | 61 | 7 | 68 |
| 2015 Mayo | 74 | 3 | 77 |
| 2015 Abril | 41 | 7 | 48 |
| 2015 Marzo | 44 | 1 | 45 |
| 2015 Febrero | 51 | 4 | 55 |
| 2015 Enero | 43 | 9 | 52 |
| 2014 Diciembre | 31 | 3 | 34 |
| 2014 Noviembre | 30 | 5 | 35 |
| 2014 Octubre | 22 | 5 | 27 |
| 2014 Septiembre | 4 | 2 | 6 |
| 2014 Agosto | 0 | 1 | 1 |
| 2014 Julio | 4 | 0 | 4 |
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