Case and Research Letters
Increased Sensitization to Kathon CG (Methylchloroisothiazolinone plus methylisothiazolinone) in the South of Gran Canaria, Spain
Aumento de sensibilización al Kathon CG® (clorometilisotiazolinona/metilisotiazolinona) en el área sur de Gran Canaria
F. Liuti
, Z. Hernández Hernández, L. Borrego Hernando
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Servicio de Dermatología, Complejo Hospitalario Universitario Insular Materno Infantil, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Liuti, Z. Hernández Hernández, L. Borrego Hernando" "autores" => array:3 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Liuti" "email" => array:1 [ 0 => "federica_liuti@libero.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Z." "apellidos" => "Hernández Hernández" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Borrego Hernando" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario Insular Materno Infantil, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aumento de sensibilización al Kathon CG<span class="elsevierStyleSup">®</span> (clorometilisotiazolinona/metilisotiazolinona) en el área sur de Gran Canaria" ] ] "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" => 1312 "Ancho" => 1653 "Tamanyo" => 129426 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Frequency of sensitization to Kathon CG by study year.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Kathon CG is a preservative that contains methylchloroisothiazolinone (MCLI) and methylisothiazolinone (MI) in a 3 to 1 ratio. It is used in cosmetics as well as in industrial and domestic cleaning products. An increase in sensitization to MCLI/MI has recently been reported, probably due to an increase in sensitization to the MI component.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We have performed a retrospective analysis of the data from patients who underwent patch testing in our hospital to discover whether this situation has also arisen in our setting. The sample of patients sensitized to MCLI/MI includes from January 1, 2005, to July 31, 2013, and the sample of those sensitized to MI includes from January 1, 2012, to July 31, 2013. The χ<span class="elsevierStyleSup">2</span> test (Epidat 4.0<span class="elsevierStyleSup">®</span>, Servicio Gallego de Salud) was used to determine whether significant differences existed between the groups studied. Sensitization to MCLI/MI was diagnosed using the True Test (Smartpractice DENMARK ApS, Hillerød, Denmark) and all patients evaluated during the study period underwent patch testing for MI at a concentration of 0.05%<span class="elsevierStyleHsp" style=""></span>in water (alergEAZE, MartiTor, Barcelona) and at 0.2%<span class="elsevierStyleHsp" style=""></span>in water in those patients patch tested with the cosmetics series (Chemotecnique, Vellinge, Sweden).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patch testing for MCLI/MI was performed in 863 patients, of whom 85 (9.85%) were sensitized. Analysis of the frequency of sensitization by years revealed a marked increase starting in the year 2010 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). When the study period was divided at the 2010 time point, we observed an increase in the frequency of sensitization from 5.97% to 14.11% (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05, χ<span class="elsevierStyleSup">2</span> test). Comparison of the MOAHLFA indices of the sensitized patients in these 2 periods showed no significant differences; this would suggest there had been no epidemiological changes that might justify this increase in frequency. However, evaluation of the cause of the eczema showed a statistically significant increase in sensitization related to the use of cosmetic products in the second period (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05, χ<span class="elsevierStyleSup">2</span> test) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">MI was studied in 195 patients, of whom 8.2% (16 patients) were sensitized. It should be noted that 5 of the 16 patients patch tested with MI at both concentrations (0.05% and 0.2%) were negative at the lower concentration. All the patients sensitized to MI were positive with MCLI/MI, and 50% of those sensitized to MCLI/MI were positive with MI.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Since its introduction in the eighties, MCLI/MI has been found to be a powerful sensitizer, and the maximum permissible concentration in cosmetic products has therefore been reduced to 15<span class="elsevierStyleHsp" style=""></span>ppm. Despite this regulation, the frequency of sensitization prior to 2008 was stable in Europe at levels between 1% and 4%,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and in Spain at figures between 3% and 4%.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> However, since that date, the frequency of sensitization in Europe has doubled<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,6</span></a> and, in 2012, reached 8% in Spain.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Our data show that sensitization levels were already very high and that they have doubled in the past 3 years.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2005, MI was approved for use in cosmetic products at a maximum concentration of 100<span class="elsevierStyleHsp" style=""></span>ppm, but its concentration has not been regulated in industrial products. It is estimated that the prevalence of sensitization to MI in Europe was around 1.5% prior to 2010, and it has increased in parallel with MCLI/MI sensitization in recent years. This finding allows us to state that this new sensitization “epidemic” to MCLI/MI is due in large part to the increase in primary sensitization to MI.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In our population, both the high frequency of sensitization to MI (8.2% in the period evaluated), and the close parallel with the results of patients positive to MCLI/MI would favor this conclusion. The results presented also support the current recommendation to perform patch testing for MI at a concentration of 2000<span class="elsevierStyleHsp" style=""></span>ppm, as there is a loss of sensitivity when the test is performed with a concentration of 500<span class="elsevierStyleHsp" style=""></span>ppm. According to the main European studies, patch testing only the MCLI/MI mixture, without independently testing MI, would fail to detect between 30% and 60% of patients sensitized to MI<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>; however, all our patients sensitized to MI were positive to MCLI/MI. Our patients were patch tested with MCLI/MI in the TrueTest and not with this allergen diluted in water. The technique is thus different and the data are not therefore wholly comparable.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, there is a high frequency of sensitization to MCLI/MI in Spain, and it has increased significantly since 2010. This requires regulation sooner rather than later to control the use of MI both in cosmetics and in industrial products.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Liuti F, Hernández Hernández Z, Borrego Hernando L. Aumento de sensibilización al Kathon CG<span class="elsevierStyleSup">®</span> (clorometilisotiazolinona/metilisotiazolinona) en el área sur de Gran Canaria. Actas Dermosifiliogr. 2014;105:882–883.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1312 "Ancho" => 1653 "Tamanyo" => 129426 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Frequency of sensitization to Kathon CG by study year.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "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="" 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">Study Population(863 Patients) \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">Positive to MCLI/MI(85 Patients) \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">Positive to MCLI/MI 2005-2009(27 of 457 Patients) \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">Positive to MCLI/MI 2010 to June 2013(58 of 411 Patients) \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">M <span class="elsevierStyleItalic">(male)</span> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.35% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.76% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.74% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.59% \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">O <span class="elsevierStyleItalic">(occupational)</span> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.20% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.76% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.52% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.62% \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">A <span class="elsevierStyleItalic">(atopy)</span> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.34% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.88% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.04% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.69% \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">H <span class="elsevierStyleItalic">(hand)</span> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.91% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.35% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.74% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.38% \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">L <span class="elsevierStyleItalic">(leg)</span> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.79% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.29% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.44% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.03% \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">F <span class="elsevierStyleItalic">(face)</span> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.95% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.18% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.44% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.66% \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">A <span class="elsevierStyleItalic">(age</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">40)</span> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.14% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.35% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.26% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.34% \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">Cosmetic origin<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.22% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.53% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.93% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.72% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab576624.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Cosmetic-related contact allergic eczema.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">MOAHLFA Index of the Study Population and of the Subgroup of Patients Sensitized to MCLI/MI.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recent increase in allergic reactions to methylchloroisothiazolinone/methylisothiazolinone: Is methylisothiazolinone the culprit?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Geier" 1 => "H. Lessmann" 2 => "A. Schnuch" 3 => "W. Uter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0536.2012.02157.x" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2012" "volumen" => "67" "paginaInicial" => "334" "paginaFinal" => "341" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22994269" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current patch test results with the European baseline series and extensions to it from the “European Surveillance System on Contact Allergy” network, 2007-2008" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Uter" 1 => "W. Aberer" 2 => "J.C. Armario-Hita" 3 => "J.M. Fernandez-Vozmediano" 4 => "F. 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Silvestre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2010.10.015" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2011" "volumen" => "102" "paginaInicial" => "98" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21354542" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methylisothiazolinone contact allergy–a growing epidemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.D. Lundov" 1 => "M.S. Opstrup" 2 => "J.D. Johansen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cod.12149" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2013" "volumen" => "69" "paginaInicial" => "271" "paginaFinal" => "275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24117738" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methylchloroisothiazolinone and methylisothiazolinone contact allergy: A new “epidemic”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Urwin" 1 => "M. Wilkinson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cod.12064" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2013" "volumen" => "68" "paginaInicial" => "253" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23510349" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio multicéntrico del GEIDAC con la serie estándar de pruebas alérgicas de contacto en 2012" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Hervella-Garcés" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "59 Reunión del Grupo Español en Investigación de Dermatitis de Contacto y Alergia Cutánea" "conferencia" => "Vigo, septiembre 20-21" "serieFecha" => "2013" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methylisothiazolinone" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.P. Castanedo-Tardana" 1 => "K.A. Zug" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DER.0b013e31827edc73" "Revista" => array:6 [ "tituloSerie" => "Dermatitis" "fecha" => "2013" "volumen" => "24" "paginaInicial" => "2" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23340392" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000009/v1_201410280115/S1578219014002583/v1_201410280115/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/15782190/0000010500000009/v1_201410280115/S1578219014002583/v1_201410280115/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014002583?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 6 | 13 |
| 2024 Octubre | 108 | 45 | 153 |
| 2024 Septiembre | 89 | 14 | 103 |
| 2024 Agosto | 106 | 56 | 162 |
| 2024 Julio | 103 | 35 | 138 |
| 2024 Junio | 98 | 35 | 133 |
| 2024 Mayo | 70 | 35 | 105 |
| 2024 Abril | 83 | 21 | 104 |
| 2024 Marzo | 80 | 37 | 117 |
| 2024 Febrero | 66 | 37 | 103 |
| 2024 Enero | 44 | 29 | 73 |
| 2023 Diciembre | 56 | 15 | 71 |
| 2023 Noviembre | 56 | 24 | 80 |
| 2023 Octubre | 72 | 19 | 91 |
| 2023 Septiembre | 62 | 31 | 93 |
| 2023 Agosto | 43 | 21 | 64 |
| 2023 Julio | 51 | 38 | 89 |
| 2023 Junio | 58 | 23 | 81 |
| 2023 Mayo | 50 | 22 | 72 |
| 2023 Abril | 43 | 20 | 63 |
| 2023 Marzo | 48 | 26 | 74 |
| 2023 Febrero | 35 | 26 | 61 |
| 2023 Enero | 42 | 27 | 69 |
| 2022 Diciembre | 53 | 44 | 97 |
| 2022 Noviembre | 34 | 32 | 66 |
| 2022 Octubre | 37 | 19 | 56 |
| 2022 Septiembre | 27 | 35 | 62 |
| 2022 Agosto | 26 | 35 | 61 |
| 2022 Julio | 21 | 29 | 50 |
| 2022 Junio | 22 | 28 | 50 |
| 2022 Mayo | 37 | 46 | 83 |
| 2022 Abril | 57 | 31 | 88 |
| 2022 Marzo | 32 | 44 | 76 |
| 2022 Febrero | 41 | 26 | 67 |
| 2022 Enero | 42 | 32 | 74 |
| 2021 Diciembre | 38 | 35 | 73 |
| 2021 Noviembre | 66 | 37 | 103 |
| 2021 Octubre | 82 | 41 | 123 |
| 2021 Septiembre | 33 | 39 | 72 |
| 2021 Agosto | 29 | 21 | 50 |
| 2021 Julio | 25 | 31 | 56 |
| 2021 Junio | 28 | 24 | 52 |
| 2021 Mayo | 29 | 28 | 57 |
| 2021 Abril | 50 | 43 | 93 |
| 2021 Marzo | 58 | 14 | 72 |
| 2021 Febrero | 60 | 33 | 93 |
| 2021 Enero | 32 | 17 | 49 |
| 2020 Diciembre | 24 | 15 | 39 |
| 2020 Noviembre | 30 | 18 | 48 |
| 2020 Octubre | 33 | 4 | 37 |
| 2020 Septiembre | 29 | 16 | 45 |
| 2020 Agosto | 36 | 10 | 46 |
| 2020 Julio | 32 | 6 | 38 |
| 2020 Junio | 26 | 21 | 47 |
| 2020 Mayo | 23 | 21 | 44 |
| 2020 Abril | 34 | 12 | 46 |
| 2020 Marzo | 22 | 17 | 39 |
| 2020 Febrero | 6 | 1 | 7 |
| 2020 Enero | 4 | 7 | 11 |
| 2019 Diciembre | 4 | 13 | 17 |
| 2019 Noviembre | 4 | 7 | 11 |
| 2019 Octubre | 0 | 6 | 6 |
| 2019 Septiembre | 4 | 4 | 8 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 2 | 6 |
| 2019 Junio | 4 | 8 | 12 |
| 2019 Mayo | 5 | 24 | 29 |
| 2019 Abril | 2 | 1 | 3 |
| 2019 Marzo | 0 | 7 | 7 |
| 2019 Febrero | 3 | 0 | 3 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 21 | 1 | 22 |
| 2018 Enero | 32 | 8 | 40 |
| 2017 Diciembre | 32 | 8 | 40 |
| 2017 Noviembre | 35 | 2 | 37 |
| 2017 Octubre | 18 | 4 | 22 |
| 2017 Septiembre | 29 | 7 | 36 |
| 2017 Agosto | 39 | 3 | 42 |
| 2017 Julio | 33 | 6 | 39 |
| 2017 Junio | 36 | 11 | 47 |
| 2017 Mayo | 34 | 12 | 46 |
| 2017 Abril | 23 | 7 | 30 |
| 2017 Marzo | 16 | 13 | 29 |
| 2017 Febrero | 18 | 6 | 24 |
| 2017 Enero | 17 | 8 | 25 |
| 2016 Diciembre | 41 | 8 | 49 |
| 2016 Noviembre | 41 | 28 | 69 |
| 2016 Octubre | 37 | 21 | 58 |
| 2016 Septiembre | 0 | 3 | 3 |
| 2016 Agosto | 0 | 4 | 4 |
| 2016 Julio | 6 | 1 | 7 |
| 2016 Junio | 17 | 3 | 20 |
| 2016 Mayo | 10 | 6 | 16 |
| 2016 Abril | 12 | 23 | 35 |
| 2016 Marzo | 9 | 7 | 16 |
| 2016 Febrero | 13 | 8 | 21 |
| 2016 Enero | 18 | 15 | 33 |
| 2015 Diciembre | 8 | 12 | 20 |
| 2015 Noviembre | 11 | 4 | 15 |
| 2015 Octubre | 6 | 1 | 7 |
| 2015 Septiembre | 7 | 1 | 8 |
| 2015 Agosto | 10 | 1 | 11 |
| 2015 Julio | 34 | 8 | 42 |
| 2015 Junio | 40 | 4 | 44 |
| 2015 Mayo | 20 | 11 | 31 |
| 2015 Abril | 9 | 9 | 18 |
| 2015 Marzo | 21 | 9 | 30 |
| 2015 Febrero | 9 | 3 | 12 |
| 2015 Enero | 6 | 3 | 9 |
| 2014 Diciembre | 8 | 5 | 13 |
| 2014 Noviembre | 9 | 1 | 10 |
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