Case and Research Letters
Skin Rash as the Only Manifestation of Mild Decompression Sickness
Erupción cutánea como única manifestación de enfermedad descompresiva leve
I. Pérez-López
, G. Blasco-Morente, R. Ruiz-Villaverde, J. Tercedor-Sánchez
Autor para correspondencia
Unidad de Gestión Clínica de Dermatología Médico Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, Spain
Leído
9544
Vecesse ha leído el artículo
2475
Total PDF
7069
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219015001572" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.05.017" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "1100" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2014" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:515-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1258 "formatos" => array:3 [ "EPUB" => 51 "HTML" => 579 "PDF" => 628 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731014005110" "issn" => "00017310" "doi" => "10.1016/j.ad.2014.11.010" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "1100" "copyright" => "Elsevier España, S.L.U. y AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:515-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 891 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 504 "PDF" => 385 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cartas científico-clínicas</span>" "titulo" => "Erupción cutánea como única manifestación de enfermedad descompresiva leve" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "515" "paginaFinal" => "516" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Skin Rash as the Only Manifestation of Mild Decompression Sickness" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 909 "Ancho" => 995 "Tamanyo" => 90522 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erupción macular de aspecto purpúrico-violáceo reticular en abdomen. Imagen realizada 24<span class="elsevierStyleHsp" style=""></span>h tras la inmersión.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Pérez-López, G. Blasco-Morente, R. Ruiz-Villaverde, J. Tercedor-Sánchez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Pérez-López" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Blasco-Morente" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Tercedor-Sánchez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219015001572" "doi" => "10.1016/j.adengl.2015.05.017" "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/S1578219015001572?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014005110?idApp=UINPBA000044" "url" => "/00017310/0000010600000006/v1_201506300045/S0001731014005110/v1_201506300045/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219015001584" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.05.018" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "1107" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:516-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1186 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 669 "PDF" => 465 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Primary Cutaneous Mucormycosis Due to <span class="elsevierStyleItalic">Saksenaea vasiformis</span> in an Immunocompetent Patient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "516" "paginaFinal" => "518" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mucormicosis cutánea primaria por <span class="elsevierStyleItalic">Saksenaea vasiformis</span> en paciente inmunocompetente" ] ] "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" => 677 "Ancho" => 900 "Tamanyo" => 112798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Forearm 3 months later. The ulcer had almost completely re-epithelialized following treatment with amphotericin B, surgical debridement of the wound, and topical application of silver sulfadiazine.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I.M. Coronel-Pérez, E.M. Rodríguez-Rey, L. Castilla-Guerra, M.C. Domínguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I.M." "apellidos" => "Coronel-Pérez" ] 1 => array:2 [ "nombre" => "E.M." "apellidos" => "Rodríguez-Rey" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Castilla-Guerra" ] 3 => array:2 [ "nombre" => "M.C." "apellidos" => "Domínguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015000046" "doi" => "10.1016/j.ad.2014.12.005" "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/S0001731015000046?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001584?idApp=UINPBA000044" "url" => "/15782190/0000010600000006/v1_201506260207/S1578219015001584/v1_201506260207/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219015001560" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.05.016" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "1097" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:514-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 758 "formatos" => array:3 [ "EPUB" => 40 "HTML" => 482 "PDF" => 236 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Casa an Research Letters</span>" "titulo" => "Fragomented Health Care Delivery in Ichthyosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "515" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dispersión en la atención médica de los pacientes con ictiosis" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Hernández-Martín, P. Dávila'Seijo, J.M. Soria de Francisco, M.I. Arroyo-Manzanal, I. García-Doval" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Hernández-Martín" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Dávila'Seijo" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Soria de Francisco" ] 3 => array:2 [ "nombre" => "M.I." "apellidos" => "Arroyo-Manzanal" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "García-Doval" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731014005080" "doi" => "10.1016/j.ad.2014.10.016" "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/S0001731014005080?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001560?idApp=UINPBA000044" "url" => "/15782190/0000010600000006/v1_201506260207/S1578219015001560/v1_201506260207/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Skin Rash as the Only Manifestation of Mild Decompression Sickness" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "515" "paginaFinal" => "516" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Pérez-López, G. Blasco-Morente, R. Ruiz-Villaverde, J. Tercedor-Sánchez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Pérez-López" "email" => array:1 [ 0 => "ipl_elmadrono@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Blasco-Morente" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Tercedor-Sánchez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Erupción cutánea como única manifestación de enfermedad descompresiva leve" ] ] "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" => 909 "Ancho" => 995 "Tamanyo" => 102108 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Purpuric-violaceous macular rash with a reticular appearance on the abdomen. Photograph taken 24<span class="elsevierStyleHsp" style=""></span>hours after the dive.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Decompression sickness is a clinical condition characterized by the formation of bubbles of inert gas in different parts of the body; these bubbles are caused by changes to the solubility of gases triggered by pressure changes during a dive.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 55-year-old man with no personal or family history of interest who presented with a slightly pruritic rash that had appeared several hours after a recreational dive. The examination revealed a purpuric-violaceous macular rash on the trunk that was more pronounced in the supine decubitus position (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No rales could be heard in the affected area. Cutaneous ultrasound of the area showed no significant findings in the dermis or hypodermis. With a suspected diagnosis of decompression sickness, the patient underwent an echocardiogram, which revealed a patent foramen ovale measuring 9<span class="elsevierStyleHsp" style=""></span>mm in diameter; this defect is one of the predisposing factors for decompression sickness. In view of the ultrasound findings and the absence of other symptoms or significant findings in the patient's history, a diagnosis of mild decompression sickness was established. As the patient was otherwise asymptomatic, refused to undergo further tests, and showed progressive clinical improvement, we decided not to perform a skin biopsy and to administer symptomatic treatment and take a watch-and-wait approach. At the time of writing, 2 weeks after the diagnosis, the patient is free of symptoms.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Decompression sickness is caused by an increase in ambient pressure during submersion that causes an increase in the partial pressure of inhaled gases (Dalton's Law). This increase, in turn, gives rise to a pressure gradient that results in the accumulation of gases, and nitrogen in particular, that remain dissolved in the body.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> When the diver returns to the surface, the pressure gradient is reversed, causing oversaturation with gases. Above a certain level, this oversaturation gives rise to the formation of bubbles in different parts of the body. The bubbles trigger a series of responses, such as increased platelet aggregation, capillary permeability and vasoconstriction, that complicate the elimination of gas even further. Predisposing factors to decompression sickness include intense physical activity before, during, or after the dive; diving in cold water (vasoconstriction); associated malformations, in particular patent foramen ovale,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> which may be asymptomatically present in up to 40% of the population (as it was in our patient); abnormal arteriovenous communications or other cardiocirculatory alterations; successive dives of between 10<span class="elsevierStyleHsp" style=""></span>minutes and 12<span class="elsevierStyleHsp" style=""></span>hours after the first dive; obesity due to increased solubility of nitrogen in adipose tissue; hypobaric exposure after diving; female sex; and repetitive dives in a short period of time.</p><p id="par0020" class="elsevierStylePara elsevierViewall">There are 2 clinical variants of decompression sickness. The first variant, type 1, is the least serious type and is characterized by cutaneous involvement in the form of a purpuric macular-papular rash (which needs to be distinguished from an allergic reaction), joint pain, or edema. Type 2 is a more severe variant characterized by neurological, respiratory, and/or cardiocirculatory involvement. Rapid diagnosis and treatment is essential as it can considerably reduce the risk of complications and death.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,3–6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In more severe cases, basic care consists of treatment in a hyperbaric chamber with delivery of 100% oxygen. Institution of hyperbaric oxygen therapy should not delay the performance of complementary tests (complete blood count, full biochemistry, gasometry, electrocardiogram, chest radiograph).<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,6,7</span></a> It may also be necessary to administer fluid therapy with saline solution to treat hypovolemia and antiplatelet therapy to counteract platelet aggregation. Associated complications should also be treated.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> In mild cases, such as ours, treatment is symptomatic provided that relevant tests have ruled out the involvement of other organs.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, cutaneous manifestations of decompression sickness may be the first sign of a series of events associated with high morbidity and mortality, particularly in cases of delayed diagnosis and treatment. The lack of reports in the literature of cutaneous manifestations of decompression sickness should not lead us to underestimate the potential gravity of this situation.</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: Pérez-López I, Blasco-Morente G, Ruiz-Villaverde R, Tercedor-Sánchez J. Erupción cutánea como única manifestación de enfermedad descompresiva leve. Actas Dermosifiliogr. 2015;106:515–516.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 909 "Ancho" => 995 "Tamanyo" => 102108 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Purpuric-violaceous macular rash with a reticular appearance on the abdomen. Photograph taken 24<span class="elsevierStyleHsp" style=""></span>hours after the dive.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyperbaric oxygen treatment for decompression sickness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.E. Moon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Undersea Hyperb Med" "fecha" => "2014" "volumen" => "41" "paginaInicial" => "151" "paginaFinal" => "157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24851553" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Viewpoint: The type A- and the type B-variants of Decompression Sickness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.E. Koch" 1 => "H. Wegner-Bröse" 2 => "V. Warninghoff" 3 => "G. Deuschl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Undersea Hyperb Med" "fecha" => "2008" "volumen" => "35" "paginaInicial" => "91" "paginaFinal" => "97" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18500073" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of patent foramen ovale (PFO) and MRI-lesions in mild neurological decompression sickness (type B-DCS/AGE)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.E. Koch" 1 => "H. Kirsch" 2 => "M. Reuter" 3 => "V. Warninghoff" 4 => "H. Rieckert" 5 => "G. Deuschl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Undersea Hyperb Med" "fecha" => "2008" "volumen" => "35" "paginaInicial" => "197" "paginaFinal" => "205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18619115" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A cutaneous decompression sickness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Tasios" 1 => "G.G. Sidiras" 2 => "V. Kalentzos" 3 => "Pyrasopoulou" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diving Hyperb Med" "fecha" => "2014" "volumen" => "44" "paginaInicial" => "45" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24687485" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous manifestation of decompression sickness: Cutis marmorata" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. Oode" 1 => "Y. Yanagawa" 2 => "T. Inoue" 3 => "K. Oomori" 4 => "H. Osaka" 5 => "K. Okamoto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Intern Med" "fecha" => "2013" "volumen" => "52" "paginaInicial" => "2479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24190159" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aquatic sports dematoses. Part 2 - in the water: Saltwater dermatoses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.E. Tlougan" 1 => "J.O. Podjasek" 2 => "B.B. Adams" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2010.04476.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2010" "volumen" => "49" "paginaInicial" => "994" "paginaFinal" => "1002" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20883263" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Images in clinical medicine. Cutis marmorata in decompression sickness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "V.N. Kalentzos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "N Engl J Med" "fecha" => "2010" "volumen" => "10" "paginaInicial" => "e67" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack179860" "titulo" => "Acknowledgments" "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">We thank Rosa Taberner for her advice and guidance.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000006/v1_201506260207/S1578219015001572/v1_201506260207/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/15782190/0000010600000006/v1_201506260207/S1578219015001572/v1_201506260207/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001572?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 15 | 10 | 25 |
| 2024 Octubre | 146 | 56 | 202 |
| 2024 Septiembre | 173 | 40 | 213 |
| 2024 Agosto | 258 | 77 | 335 |
| 2024 Julio | 239 | 53 | 292 |
| 2024 Junio | 223 | 57 | 280 |
| 2024 Mayo | 180 | 57 | 237 |
| 2024 Abril | 167 | 37 | 204 |
| 2024 Marzo | 198 | 40 | 238 |
| 2024 Febrero | 206 | 45 | 251 |
| 2024 Enero | 165 | 42 | 207 |
| 2023 Diciembre | 187 | 20 | 207 |
| 2023 Noviembre | 182 | 30 | 212 |
| 2023 Octubre | 164 | 20 | 184 |
| 2023 Septiembre | 182 | 38 | 220 |
| 2023 Agosto | 147 | 16 | 163 |
| 2023 Julio | 189 | 36 | 225 |
| 2023 Junio | 130 | 22 | 152 |
| 2023 Mayo | 224 | 30 | 254 |
| 2023 Abril | 166 | 20 | 186 |
| 2023 Marzo | 142 | 20 | 162 |
| 2023 Febrero | 114 | 32 | 146 |
| 2023 Enero | 139 | 30 | 169 |
| 2022 Diciembre | 129 | 43 | 172 |
| 2022 Noviembre | 82 | 29 | 111 |
| 2022 Octubre | 84 | 23 | 107 |
| 2022 Septiembre | 71 | 31 | 102 |
| 2022 Agosto | 70 | 35 | 105 |
| 2022 Julio | 51 | 40 | 91 |
| 2022 Junio | 33 | 24 | 57 |
| 2022 Mayo | 92 | 34 | 126 |
| 2022 Abril | 143 | 34 | 177 |
| 2022 Marzo | 133 | 42 | 175 |
| 2022 Febrero | 132 | 31 | 163 |
| 2022 Enero | 113 | 38 | 151 |
| 2021 Diciembre | 76 | 27 | 103 |
| 2021 Noviembre | 102 | 51 | 153 |
| 2021 Octubre | 100 | 43 | 143 |
| 2021 Septiembre | 90 | 46 | 136 |
| 2021 Agosto | 71 | 25 | 96 |
| 2021 Julio | 72 | 28 | 100 |
| 2021 Junio | 68 | 27 | 95 |
| 2021 Mayo | 62 | 26 | 88 |
| 2021 Abril | 133 | 62 | 195 |
| 2021 Marzo | 88 | 17 | 105 |
| 2021 Febrero | 64 | 43 | 107 |
| 2021 Enero | 69 | 22 | 91 |
| 2020 Diciembre | 60 | 20 | 80 |
| 2020 Noviembre | 46 | 19 | 65 |
| 2020 Octubre | 47 | 12 | 59 |
| 2020 Septiembre | 37 | 19 | 56 |
| 2020 Agosto | 41 | 19 | 60 |
| 2020 Julio | 35 | 13 | 48 |
| 2020 Junio | 54 | 32 | 86 |
| 2020 Mayo | 36 | 16 | 52 |
| 2020 Abril | 37 | 34 | 71 |
| 2020 Marzo | 30 | 11 | 41 |
| 2020 Febrero | 4 | 5 | 9 |
| 2020 Enero | 0 | 1 | 1 |
| 2019 Diciembre | 0 | 5 | 5 |
| 2019 Noviembre | 0 | 2 | 2 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 0 | 2 | 2 |
| 2019 Agosto | 0 | 5 | 5 |
| 2019 Julio | 0 | 16 | 16 |
| 2019 Junio | 0 | 22 | 22 |
| 2019 Mayo | 0 | 50 | 50 |
| 2019 Abril | 0 | 62 | 62 |
| 2019 Marzo | 0 | 17 | 17 |
| 2019 Febrero | 0 | 6 | 6 |
| 2019 Enero | 0 | 6 | 6 |
| 2018 Diciembre | 1 | 8 | 9 |
| 2018 Noviembre | 0 | 1 | 1 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 3 | 16 | 19 |
| 2018 Agosto | 0 | 10 | 10 |
| 2018 Julio | 0 | 15 | 15 |
| 2018 Junio | 0 | 8 | 8 |
| 2018 Mayo | 0 | 21 | 21 |
| 2018 Abril | 0 | 17 | 17 |
| 2018 Marzo | 1 | 10 | 11 |
| 2018 Febrero | 29 | 10 | 39 |
| 2018 Enero | 36 | 9 | 45 |
| 2017 Diciembre | 43 | 20 | 63 |
| 2017 Noviembre | 25 | 7 | 32 |
| 2017 Octubre | 23 | 16 | 39 |
| 2017 Septiembre | 19 | 15 | 34 |
| 2017 Agosto | 25 | 21 | 46 |
| 2017 Julio | 20 | 17 | 37 |
| 2017 Junio | 36 | 19 | 55 |
| 2017 Mayo | 38 | 15 | 53 |
| 2017 Abril | 51 | 16 | 67 |
| 2017 Marzo | 21 | 32 | 53 |
| 2017 Febrero | 21 | 10 | 31 |
| 2017 Enero | 31 | 15 | 46 |
| 2016 Diciembre | 30 | 9 | 39 |
| 2016 Noviembre | 32 | 5 | 37 |
| 2016 Octubre | 29 | 11 | 40 |
| 2016 Septiembre | 0 | 5 | 5 |
| 2016 Agosto | 0 | 1 | 1 |
| 2016 Julio | 6 | 1 | 7 |
| 2016 Junio | 12 | 6 | 18 |
| 2016 Mayo | 8 | 2 | 10 |
| 2016 Abril | 3 | 7 | 10 |
| 2016 Marzo | 11 | 12 | 23 |
| 2016 Febrero | 12 | 1 | 13 |
| 2016 Enero | 5 | 21 | 26 |
| 2015 Diciembre | 4 | 5 | 9 |
| 2015 Noviembre | 0 | 6 | 6 |
| 2015 Octubre | 0 | 3 | 3 |
| 2015 Septiembre | 0 | 4 | 4 |
| 2015 Agosto | 0 | 2 | 2 |
| 2015 Julio | 0 | 1 | 1 |
Mostrar todo
