Case and Research Letter
The Utility of Skin Ultrasound for the Diagnosis of Complications of Tissue Filler Materials
Utilidad de la ecografía cutánea en el diagnóstico de las complicaciones por materiales de relleno
D. Menis
, M. Castellanos-González, R. Llamas-Martín, F. Vanaclocha Sebastián
Autor para correspondencia
Servicio de Dermatología, Hospital 12 de Octubre, Madrid, Spain
Leído
5700
Vecesse ha leído el artículo
2041
Total PDF
3659
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S157821901400211X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.11.006" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "959" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:797-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1178 "formatos" => array:3 [ "EPUB" => 39 "HTML" => 833 "PDF" => 306 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731014000350" "issn" => "00017310" "doi" => "10.1016/j.ad.2013.11.012" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "959" "copyright" => "Elsevier España, S.L. y AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:797-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1373 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 942 "PDF" => 430 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Utilidad de la ecografía cutánea en el diagnóstico de las complicaciones por materiales de relleno" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "797" "paginaFinal" => "798" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The Utility of Skin Ultrasound for the Diagnosis of Complications of Tissue Filler Materials" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 667 "Ancho" => 939 "Tamanyo" => 72416 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Siliconomas con el patrón en «tormenta de nieve». Flecha roja: imagen hiperecogénica que corresponde al material de relleno. Flecha verde: sombra acústica posterior.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Menis, M. Castellanos-González, R. Llamas-Martín, F. Vanaclocha Sebastián" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Menis" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Castellanos-González" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Llamas-Martín" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Vanaclocha Sebastián" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S157821901400211X" "doi" => "10.1016/j.adengl.2013.11.006" "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/S157821901400211X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014000350?idApp=UINPBA000044" "url" => "/00017310/0000010500000008/v1_201409260036/S0001731014000350/v1_201409260036/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219014002315" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.12.007" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "960" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:799-800" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 819 "formatos" => array:3 [ "EPUB" => 35 "HTML" => 536 "PDF" => 248 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Analysis of Inpatient Dermatologic Consultations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "799" "paginaFinal" => "800" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de consultas dermatológicas de pacientes hospitalizados" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Özyurt, K.H. Kelekçi, S. Şeremet, S. Özçelik" "autores" => array:4 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Özyurt" ] 1 => array:2 [ "nombre" => "K.H." "apellidos" => "Kelekçi" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Şeremet" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Özçelik" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0001731014000362" "doi" => "10.1016/j.ad.2013.12.016" "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/S0001731014000362?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014002315?idApp=UINPBA000044" "url" => "/15782190/0000010500000008/v1_201409260034/S1578219014002315/v1_201409260034/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219014002078" "issn" => "15782190" "doi" => "10.1016/j.adengl.2013.10.012" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "958" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:795-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2266 "formatos" => array:3 [ "EPUB" => 46 "HTML" => 1613 "PDF" => 607 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Hypertrophic and Keloid Scars After the Application of 5% Imiquimod Cream: A Report of 2 Cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "795" "paginaFinal" => "797" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cicatriz hipértrofica y queloide después de la aplicación de imiquimod 5% crema. A propósito de 2 casos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1437 "Ancho" => 1801 "Tamanyo" => 327696 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Basal cell carcinoma; image taken before starting treatment. B, Large, indurated plaque with 3 linear elastic elements; image taken 2 months after starting imiquimod treatment. C, The lesion persists, but with reduced erythema.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Márquez García, T. Ojeda Vila, L. Ferrándiz Pulido, J.J. Ríos Martín" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Márquez García" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Ojeda Vila" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Ferrándiz Pulido" ] 3 => array:2 [ "nombre" => "J.J." "apellidos" => "Ríos Martín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731014000349" "doi" => "10.1016/j.ad.2013.10.018" "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/S0001731014000349?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014002078?idApp=UINPBA000044" "url" => "/15782190/0000010500000008/v1_201409260034/S1578219014002078/v1_201409260034/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "The Utility of Skin Ultrasound for the Diagnosis of Complications of Tissue Filler Materials" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "797" "paginaFinal" => "798" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Menis, M. Castellanos-González, R. Llamas-Martín, F. Vanaclocha Sebastián" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Menis" "email" => array:1 [ 0 => "diana.menis@hotmail.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Castellanos-González" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Llamas-Martín" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Vanaclocha Sebastián" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital 12 de Octubre, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la ecografía cutánea en el diagnóstico de las complicaciones por materiales de relleno" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 668 "Ancho" => 939 "Tamanyo" => 83176 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Siliconomas with a snowstorm pattern. Red arrow, hyperechoic image corresponding to the filler material. Green arrow, posterior acoustic shadow.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The increase in the number of cosmetic procedures in recent years means that in our daily practice we are seeing ever more side effects of the different techniques. One of these is the formation of granulomas secondary to dermal fillers; the etiology of these lesions can be difficult to determine, not only because patients neglect to inform us they have undergone cosmetic treatment or they are unaware of the type of material used, but also because the clinical presentation can be similar to that of certain dermatologic diseases.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> When medicolegal issues arise, the most useful additional test is biopsy, as each material presents a specific histologic pattern,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> but this is an invasive technique and patients may sometimes reject such tests. Skin ultrasound is an alternative, non-invasive test that, through specific sonographic patterns, can identify the type of material involved and its exact site.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 52-year-old woman who came to outpatients for multiple asymptomatic lesions on the forehead. The first lesions had appeared in the glabellar region 8 years earlier and had remained stable until the year prior to consultation when, coinciding with the appearance of new lesions, she developed recurrent episodes of inflammation that persisted for several days and resolved spontaneously. Physical examination revealed yellowish-pink plaques of 1-2<span class="elsevierStyleHsp" style=""></span>cm diameter, with well-defined borders, a firm consistency, and a peau d’orange appearance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The only finding of interest in the patient's past history was the injection of a filler material 14 years earlier; she was unable to specify what the material was. On biopsy there were abundant foamy histiocytes suggestive of a histiocytic reaction to the filler material (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Due to the lack of specific findings, we decided to perform skin ultrasound to identify the filler material employed. The study revealed hyperechoic images that had no clearly visible border and that left an acoustic shadow; the images were present in the skin and deeper tissues of the frontal and malar regions and of the chin. The sonographic pattern corresponded to the so-called snowstorm sign (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), which is compatible with a diagnosis of siliconomas. In this case, skin ultrasound enabled us to define the type of material employed and its presence in other areas in addition to those in which the patient stated the injections had been performed. This made it possible to plan management. At the time of writing, the patient had completed 3 months of treatment with isotretinoin, 0.4<span class="elsevierStyleHsp" style=""></span>mg/kg/d, which has led to a partial improvement in the lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">High-frequency ultrasound is a simple and rapid non-invasive technique with a good cost-efficacy relationship. The technique enables us to identify the nature, volume, and site of the injected material. The thickness of the soft tissues does not affect image quality, and the material in question can be identified in 97.5% of cases.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Ultrasound can differentiate between reabsorbable and permanent filler materials, though it cannot distinguish between different materials of the same class. Absorbable materials are seen as anechoic or hypoechoic masses with the appearance of cysts whereas permanent materials produce a hyperechoic pattern; semiabsorbable materials are seen as hypoechoic areas that contain foci of variable echogenicity. Liquid silicone can produce a specific pattern known as a snowstorm pattern because of the presence of multiple hyperechoic collections with an acoustic shadow.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We consider that skin ultrasound can be very useful when filler materials give rise to complications and it can provide a valid alternative for those patients who, for whatever reason, do not wish to undergo biopsy. Ultrasound establishes the clinical diagnosis more accurately than other imaging studies—the presence of a permanent material, such as calcium hydroxyapatite, can give false positive results with magnetic resonance, computed tomography, and positron emission tomography.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In addition, ultrasound can aid decision-taking regarding subsequent treatment as, for example, the presence of a permanent filler material would contraindicate treatment with interferon.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Ultrasound can also help us to orient patients about the prognosis as, in contrast to reabsorbable filler materials, granulomatous reactions to permanent materials are unlikely to resolve in less than 6 months. Furthermore, knowledge of the site and nature of a filler material will make it possible to avoid future complications if further interventions are to be performed at the same site. Finally, some authors consider that ultrasound study improves the patient's awareness of the cosmetic results achieved and, in those patients not convinced of the persistence of an injected material, the ultrasound images can reinforce their perception of the definitive results.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In our opinion, although biopsy continues to be the gold standard for the definitive diagnosis of the side effects of an injected filler material, skin ultrasound is a valid and useful alternative diagnostic method in patients who reject invasive diagnostic tests.</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: Menis D, Castellanos-González M, Llamas-Martín R, Vanaclocha Sebastián F. Utilidad de la ecografía cutánea en el diagnóstico de las complicaciones por materiales de relleno. Actas Dermosifiliogr. 2014;105:797–798.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 670 "Ancho" => 951 "Tamanyo" => 66442 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Yellowish-pink plaques of variable size and with well-defined borders on the forehead.</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" => 716 "Ancho" => 952 "Tamanyo" => 260214 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Skin with abundant foamy histiocytes (some with microvacuoles and others with macrovacuoles) in the reticular dermis, suggestive of a histiocytic reaction to a filler material (hematoxylin-eosin, original magnification ×10).</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" => 668 "Ancho" => 939 "Tamanyo" => 83176 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Siliconomas with a snowstorm pattern. Red arrow, hyperechoic image corresponding to the filler material. Green arrow, posterior acoustic shadow.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma por silicona líquida" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Rubio-Flores" 1 => "M.A. Martín-Díaz" 2 => "M.J. González-Beato" 3 => "R.M. Díaz-Díaz" 4 => "C. Rubio-Flores" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifilogr" "fecha" => "2005" "volumen" => "96" "paginaInicial" => "598" "paginaFinal" => "601" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adverse reactions to injectable soft tissue fillers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Requena" 1 => "C. Requena" 2 => "L. Christensen" 3 => "U.S. Zimmermann" 4 => "H. Kutner" 5 => "L. Cerroni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2010.02.064" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2011" "volumen" => "64" "paginaInicial" => "1" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21167403" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The utility of high-frequency ultrasound in dermal filler evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.R. Grippaudo" 1 => "M. Mattei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SAP.0b013e318203ebf6" "Revista" => array:6 [ "tituloSerie" => "Ann Plast Surg" "fecha" => "2011" "volumen" => "67" "paginaInicial" => "469" "paginaFinal" => "473" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21346530" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound detection and identification of cosmetic fillers in the skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "X. Wortsman" 1 => "J. Wortsman" 2 => "C. Orlandi" 3 => "G. Cardenas" 4 => "I. Sazunic" 5 => "G.B.E. Jemec" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2011.04047.x" "Revista" => array:7 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2012" "volumen" => "26" "paginaInicial" => "292" "paginaFinal" => "301" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21418333" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1134282X1200156X" "estado" => "S300" "issn" => "1134282X" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cosmetic permanent fillers for soft tissue augmentation: A new contraindication for interferon therapies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Fischer" 1 => "G. Metzler" 2 => "M. Schaller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.143.4.507" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2007" "volumen" => "143" "paginaInicial" => "507" "paginaFinal" => "510" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17438184" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reacción granulomatosa a cuerpo extraño a sílice, silicona y ácido hialurónico, en paciente con sarcoidosis inducida por interferón" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Novoa" 1 => "M.A. Barnadas" 2 => "X. Torras" 3 => "R. Curell" 4 => "A. Alomar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2012.07.007" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2013" "volumen" => "104" "paginaInicial" => "920" "paginaFinal" => "923" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22995946" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of high-frequency ultrasound in the assessment of injectable dermal fillers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.R. Young" 1 => "P.A. Bolton" 2 => "J. Downie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0846.2008.00297.x" "Revista" => array:6 [ "tituloSerie" => "Skin Res Technol" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "320" "paginaFinal" => "323" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19159378" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000008/v1_201409260034/S157821901400211X/v1_201409260034/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/15782190/0000010500000008/v1_201409260034/S157821901400211X/v1_201409260034/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901400211X?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 5 | 13 |
| 2024 Octubre | 80 | 47 | 127 |
| 2024 Septiembre | 80 | 17 | 97 |
| 2024 Agosto | 119 | 78 | 197 |
| 2024 Julio | 94 | 43 | 137 |
| 2024 Junio | 90 | 21 | 111 |
| 2024 Mayo | 65 | 44 | 109 |
| 2024 Abril | 60 | 20 | 80 |
| 2024 Marzo | 76 | 25 | 101 |
| 2024 Febrero | 66 | 37 | 103 |
| 2024 Enero | 53 | 36 | 89 |
| 2023 Diciembre | 59 | 31 | 90 |
| 2023 Noviembre | 51 | 21 | 72 |
| 2023 Octubre | 51 | 23 | 74 |
| 2023 Septiembre | 77 | 42 | 119 |
| 2023 Agosto | 58 | 18 | 76 |
| 2023 Julio | 48 | 30 | 78 |
| 2023 Junio | 62 | 23 | 85 |
| 2023 Mayo | 70 | 26 | 96 |
| 2023 Abril | 56 | 33 | 89 |
| 2023 Marzo | 65 | 24 | 89 |
| 2023 Febrero | 40 | 27 | 67 |
| 2023 Enero | 40 | 24 | 64 |
| 2022 Diciembre | 60 | 42 | 102 |
| 2022 Noviembre | 36 | 24 | 60 |
| 2022 Octubre | 33 | 37 | 70 |
| 2022 Septiembre | 39 | 53 | 92 |
| 2022 Agosto | 63 | 38 | 101 |
| 2022 Julio | 28 | 34 | 62 |
| 2022 Junio | 23 | 25 | 48 |
| 2022 Mayo | 40 | 47 | 87 |
| 2022 Abril | 56 | 46 | 102 |
| 2022 Marzo | 56 | 71 | 127 |
| 2022 Febrero | 50 | 22 | 72 |
| 2022 Enero | 66 | 44 | 110 |
| 2021 Diciembre | 44 | 42 | 86 |
| 2021 Noviembre | 53 | 36 | 89 |
| 2021 Octubre | 47 | 59 | 106 |
| 2021 Septiembre | 47 | 37 | 84 |
| 2021 Agosto | 39 | 32 | 71 |
| 2021 Julio | 28 | 34 | 62 |
| 2021 Junio | 36 | 18 | 54 |
| 2021 Mayo | 32 | 23 | 55 |
| 2021 Abril | 51 | 64 | 115 |
| 2021 Marzo | 41 | 18 | 59 |
| 2021 Febrero | 61 | 32 | 93 |
| 2021 Enero | 28 | 7 | 35 |
| 2020 Diciembre | 40 | 11 | 51 |
| 2020 Noviembre | 26 | 14 | 40 |
| 2020 Octubre | 30 | 13 | 43 |
| 2020 Septiembre | 23 | 7 | 30 |
| 2020 Agosto | 16 | 21 | 37 |
| 2020 Julio | 32 | 21 | 53 |
| 2020 Junio | 28 | 20 | 48 |
| 2020 Mayo | 31 | 14 | 45 |
| 2020 Abril | 36 | 13 | 49 |
| 2020 Marzo | 33 | 21 | 54 |
| 2020 Febrero | 6 | 1 | 7 |
| 2019 Diciembre | 4 | 2 | 6 |
| 2019 Noviembre | 0 | 2 | 2 |
| 2019 Septiembre | 4 | 1 | 5 |
| 2019 Julio | 0 | 2 | 2 |
| 2019 Junio | 2 | 0 | 2 |
| 2019 Mayo | 1 | 12 | 13 |
| 2019 Abril | 0 | 10 | 10 |
| 2019 Marzo | 2 | 7 | 9 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 5 | 0 | 5 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Agosto | 0 | 17 | 17 |
| 2018 Julio | 0 | 4 | 4 |
| 2018 Junio | 0 | 5 | 5 |
| 2018 Mayo | 0 | 6 | 6 |
| 2018 Abril | 0 | 5 | 5 |
| 2018 Marzo | 3 | 3 | 6 |
| 2018 Febrero | 21 | 2 | 23 |
| 2018 Enero | 36 | 8 | 44 |
| 2017 Diciembre | 34 | 7 | 41 |
| 2017 Noviembre | 40 | 9 | 49 |
| 2017 Octubre | 29 | 5 | 34 |
| 2017 Septiembre | 32 | 14 | 46 |
| 2017 Agosto | 49 | 10 | 59 |
| 2017 Julio | 45 | 6 | 51 |
| 2017 Junio | 45 | 8 | 53 |
| 2017 Mayo | 21 | 20 | 41 |
| 2017 Abril | 19 | 7 | 26 |
| 2017 Marzo | 16 | 11 | 27 |
| 2017 Febrero | 14 | 7 | 21 |
| 2017 Enero | 19 | 9 | 28 |
| 2016 Diciembre | 36 | 8 | 44 |
| 2016 Noviembre | 44 | 12 | 56 |
| 2016 Octubre | 38 | 11 | 49 |
| 2016 Septiembre | 1 | 6 | 7 |
| 2016 Agosto | 0 | 2 | 2 |
| 2016 Julio | 13 | 2 | 15 |
| 2016 Junio | 14 | 0 | 14 |
| 2016 Mayo | 14 | 9 | 23 |
| 2016 Abril | 11 | 0 | 11 |
| 2016 Marzo | 8 | 8 | 16 |
| 2016 Febrero | 12 | 1 | 13 |
| 2016 Enero | 8 | 2 | 10 |
| 2015 Diciembre | 12 | 3 | 15 |
| 2015 Noviembre | 12 | 2 | 14 |
| 2015 Octubre | 5 | 12 | 17 |
| 2015 Septiembre | 5 | 3 | 8 |
| 2015 Agosto | 13 | 1 | 14 |
| 2015 Julio | 32 | 4 | 36 |
| 2015 Junio | 30 | 3 | 33 |
| 2015 Mayo | 32 | 3 | 35 |
| 2015 Abril | 7 | 2 | 9 |
| 2015 Marzo | 5 | 2 | 7 |
| 2015 Febrero | 8 | 4 | 12 |
| 2015 Enero | 8 | 1 | 9 |
| 2014 Diciembre | 4 | 3 | 7 |
| 2014 Noviembre | 4 | 1 | 5 |
| 2014 Octubre | 10 | 1 | 11 |
Mostrar todo
