Case and Research Letters
Granulomatous Reactions to Red Tattoo Pigments: A Description of 5 Cases
Reacciones granulomatosas a los tatuajes rojos: presentación de 5 lesiones
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"apellidos" => "Penín" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219015001808" "doi" => "10.1016/j.adengl.2015.06.015" "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/S1578219015001808?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015000101?idApp=UINPBA000044" "url" => "/00017310/0000010600000007/v1_201509041239/S0001731015000101/v1_201509041239/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1578219015001833" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.06.017" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "1114" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:591-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1451 "formatos" => array:3 [ "EPUB" => 34 "HTML" => 556 "PDF" => 861 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Usefulness of High-Frequency Ultrasound in the Diagnosis of Piezogenic Pedal Papules" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "591" "paginaFinal" => "593" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la ecografía de alta frecuencia en el diagnóstico de las pápulas piezogénicas" ] ] "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" => 634 "Ancho" => 1400 "Tamanyo" => 95348 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Clinical photograph of piezogenic papules in a 13-year-old girl. Small, round, skin-colored papules/nodules are visible on the medial surface of the heel. B, Ultrasound image of a piezogenic papule. A round hypoechoic area is observed in the dermis. This corresponds to a fat lobule surrounded by the reticular dermis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.I. Rodríguez-Bandera, F. Alfageme Roldán, M. Hospital-Gil, R. de Lucas Laguna" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A.I." "apellidos" => "Rodríguez-Bandera" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Alfageme Roldán" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Hospital-Gil" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "de Lucas Laguna" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015000113" "doi" => "10.1016/j.ad.2014.12.011" "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/S0001731015000113?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001833?idApp=UINPBA000044" "url" => "/15782190/0000010600000007/v1_201508271313/S1578219015001833/v1_201508271313/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S157821901500178X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.06.013" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "1142" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:586-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1132 "formatos" => array:3 [ "EPUB" => 42 "HTML" => 725 "PDF" => 365 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Ultrasound Diagnosis of Calcified Skin Deposits" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "586" "paginaFinal" => "588" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Depósitos cálcicos cutáneos diagnosticados mediante ecografía" ] ] "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" => 1182 "Ancho" => 995 "Tamanyo" => 139422 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Ultrasound image. B mode: sagittal section showing increased thickness and decreased echogenicity of the dermis, compatible with inflammation, and hyperechoic deposits with a linear morphology that produce an acoustic shadow. The deposits are located in the dermis and in the subcutaneous cellular tissue. B, Ultrasound image. Doppler study: absence of flow.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Lorente-Luna, F. Alfageme Roldán, C. González Lois" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Lorente-Luna" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Alfageme Roldán" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "González Lois" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101500126X" "doi" => "10.1016/j.ad.2014.12.020" "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/S000173101500126X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901500178X?idApp=UINPBA000044" "url" => "/15782190/0000010600000007/v1_201508271313/S157821901500178X/v1_201508271313/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Granulomatous Reactions to Red Tattoo Pigments: A Description of 5 Cases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "588" "paginaFinal" => "590" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. Martín-Callizo, J. Marcoval, R.M. Penín" "autores" => array:3 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Martín-Callizo" "email" => array:1 [ 0 => "claramartincallizo@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" => "J." "apellidos" => "Marcoval" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R.M." "apellidos" => "Penín" "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 Universitari de Bellvitge, L’Hospitalet del Llobregat, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anatomía Patológica, Hospital Universitari de Bellvitge, L’Hospitalet del Llobregat, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reacciones granulomatosas a los tatuajes rojos: presentación de 5 lesiones" ] ] "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" => 911 "Ancho" => 1299 "Tamanyo" => 266673 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Lesion No. 2: The image shows erosions and release of material to the red areas of a multicolored tattoo on the dorsum of the right foot (B). C, Granuloma annulare lesions can be observed on the dorsum of the left foot.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tattooing has been practiced for more than 8000 years. During the last 30 years, the practice has spread widely in developed countries.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Complications of tattooing include transmission of infectious diseases (mainly mycobacterial diseases, which are often associated with the color gray, through use of nonsterile water as a diluent), underlying skin diseases resulting from an isomorphic process, and even tumors at the site of the tattoo. Furthermore, injecting a foreign substance into the skin can induce a toxic or immune response.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the characteristics of the study patients. The first case involved a woman who experienced intense itching and raised red areas after receiving a multicolored tattoo (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The following patient, who had granuloma annulare as a child, experienced itching in the red areas of a multicolored tattoo (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A), in which some parts were raised and others eroded, with production of material (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Brownish maculopapular lesions appeared 1 month later, taking on an irregular circinate pattern on the dorsum of the foot and distal end of the lower left leg (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Histopathology of the lesions revealed granuloma annulare. The third patient had received a green and red tattoo, which progressed with subcutaneous nodules that became ulcerated on the red areas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). The fourth patient complained of itching and inflammation on the red areas of a tattoo placed on her right wrist 15 days earlier. The inflammation progressed to forma a large ulcer (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Five months after the onset of symptoms on the wrist, the patient also complained of inflammation and discomfort on a tattoo that had been placed 5 years previously (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histopathology of the 5 lesions revealed an inflammatory reaction with multiple multinucleated giant cells and pigment compatible with foreign body granuloma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The results of microbiology studies based on staining and culture (including mycobacteria) were negative for all 5 lesions. In the second case, systemic sarcoidosis was ruled out by chest x-ray and determination of angiotensin-converting enzyme in blood.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Adverse cutaneous hypersensitivity reactions to tattoos are not uncommon and are attributed to the materials injected. Red is the color most commonly associated with adverse reactions. Red tattoo pigments were traditionally made from mercury derivatives, then from cadmium derivatives, which are currently prohibited because of toxicity.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> Today, tattoos contain synthetic organic pigments, which carry a lower risk of adverse reactions. The problem is that there are no strict regulations on pigment content, and most professional tattoo artists do not know the composition of the pigments they use.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> People receiving a tattoo are for the most part unaware of the substances being injected and of their possible adverse effects. In 2008, the Spanish Agency for Medications and Medical Devices drafted a list of authorized registered products that should not exceed the maximum limits for harmful substances, such as mercury, lead, and arsenic.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> In any case, the exact composition of each of the products used is unknown.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The histopathologic patterns produced by adverse reaction to a tattoo are diverse, the most frequent being a lichenoid pattern. Other types of reactions to tattoos include eczematous, pseudolymphomatous, and sclerodermiform reactions, as well as perforating collagenosis, and, as in the cases we report, granulomatous reactions.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Although very rare, sarcoid granulomas can be found within a tattoo. This finding can be the only clinical manifestation of systemic sarcoidosis.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We observed 1 case of granuloma annulare that occurred simultaneously with and at a distance from a granulomatous reaction to red tattoo pigment. The literature contains several cases of granuloma annulare limited to the red areas of the tattoo,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> but not distant lesions. The etiologic and pathogenic mechanisms of granuloma annulare remain unknown, although it is postulated that altered collagen and elastic fibers could trigger the immune response.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Cutaneous reactions to tattoo pigment are treated mainly with topical corticosteroids. Reactions to red pigment have been treated with Q-switched Nd:YAG laser, which carries a risk of severe allergic reactions resulting from lysis of phagocytes and release of pigment into the extracellular space.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The increased frequency of tattooing in our setting means that dermatologists should be aware of potential side effects and able to diagnose them correctly. We believe that people who wish to have a tattoo should be informed of the risk of severe reactions, especially when red pigment is used.</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: Martín-Callizo C, Marcoval J, Penín RM. Reacciones granulomatosas a los tatuajes rojos: presentación de 5 lesiones. Actas Dermosifiliogr. 2015;106:588–590.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 808 "Ancho" => 1300 "Tamanyo" => 269782 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Lesion No. 1: The image shows inflammation of the red areas in a multicolored tattoo. B, Lesion No. 3: The image shows ulceration and inflammation on the red area of a red and green tattoo. C, Lesion No. 4: The image shows a large ulcer in the red areas of a green, red, and black tattoo. D, Lesion No. 5: The image shows inflammation of the red area of a tattoo that first appeared 5 months after the appearance of lesion No. 4 in the same patient.</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" => 911 "Ancho" => 1299 "Tamanyo" => 266673 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Lesion No. 2: The image shows erosions and release of material to the red areas of a multicolored tattoo on the dorsum of the right foot (B). C, Granuloma annulare lesions can be observed on the dorsum of the left foot.</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" => 939 "Ancho" => 1300 "Tamanyo" => 511559 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology study of lesions resulting from a granulomatous reaction to a tattoo. Granulomas can be observed in the superficial dermis (A, hematoxylin-eosin [H-E] ×<span class="elsevierStyleHsp" style=""></span>4) and deep dermis (B, H-E ×<span class="elsevierStyleHsp" style=""></span>4). Greater magnification reveals foreign body granulomas around the pigment (C, H-E ×<span class="elsevierStyleHsp" style=""></span>10) and phagocytic cells filled with red pigment (D, H-E ×<span class="elsevierStyleHsp" style=""></span>40).</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "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=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lesion \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Agey \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time Between Tattoo and Onset of Symptoms \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical Appearance \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Erythema/Inflammation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsum of right foot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Erosion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intralesional corticosteroid \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right ankle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ulcer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical antibiotic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right wrist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ulcer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical, oral, and intralesional corticosteroids. Excision \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">><span class="elsevierStyleHsp" style=""></span>5 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left ankle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Erythema/Inflammation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab873593.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Characteristics of 5 Lesions in 4 Patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Red tattoo reactions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.J. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 21 | 9 | 30 |
| 2024 Octubre | 159 | 50 | 209 |
| 2024 Septiembre | 154 | 52 | 206 |
| 2024 Agosto | 234 | 92 | 326 |
| 2024 Julio | 199 | 65 | 264 |
| 2024 Junio | 163 | 54 | 217 |
| 2024 Mayo | 164 | 48 | 212 |
| 2024 Abril | 149 | 34 | 183 |
| 2024 Marzo | 198 | 39 | 237 |
| 2024 Febrero | 278 | 36 | 314 |
| 2024 Enero | 166 | 36 | 202 |
| 2023 Diciembre | 180 | 27 | 207 |
| 2023 Noviembre | 212 | 30 | 242 |
| 2023 Octubre | 174 | 24 | 198 |
| 2023 Septiembre | 201 | 31 | 232 |
| 2023 Agosto | 268 | 23 | 291 |
| 2023 Julio | 147 | 43 | 190 |
| 2023 Junio | 155 | 28 | 183 |
| 2023 Mayo | 141 | 22 | 163 |
| 2023 Abril | 208 | 37 | 245 |
| 2023 Marzo | 220 | 30 | 250 |
| 2023 Febrero | 190 | 24 | 214 |
| 2023 Enero | 121 | 34 | 155 |
| 2022 Diciembre | 130 | 51 | 181 |
| 2022 Noviembre | 78 | 38 | 116 |
| 2022 Octubre | 69 | 55 | 124 |
| 2022 Septiembre | 86 | 43 | 129 |
| 2022 Agosto | 71 | 45 | 116 |
| 2022 Julio | 78 | 47 | 125 |
| 2022 Junio | 71 | 33 | 104 |
| 2022 Mayo | 186 | 45 | 231 |
| 2022 Abril | 210 | 50 | 260 |
| 2022 Marzo | 141 | 61 | 202 |
| 2022 Febrero | 125 | 36 | 161 |
| 2022 Enero | 120 | 49 | 169 |
| 2021 Diciembre | 133 | 40 | 173 |
| 2021 Noviembre | 153 | 48 | 201 |
| 2021 Octubre | 143 | 52 | 195 |
| 2021 Septiembre | 128 | 37 | 165 |
| 2021 Agosto | 129 | 21 | 150 |
| 2021 Julio | 118 | 25 | 143 |
| 2021 Junio | 104 | 27 | 131 |
| 2021 Mayo | 84 | 34 | 118 |
| 2021 Abril | 219 | 73 | 292 |
| 2021 Marzo | 114 | 42 | 156 |
| 2021 Febrero | 100 | 34 | 134 |
| 2021 Enero | 73 | 26 | 99 |
| 2020 Diciembre | 67 | 29 | 96 |
| 2020 Noviembre | 45 | 31 | 76 |
| 2020 Octubre | 94 | 15 | 109 |
| 2020 Septiembre | 34 | 16 | 50 |
| 2020 Agosto | 41 | 18 | 59 |
| 2020 Julio | 27 | 21 | 48 |
| 2020 Junio | 34 | 33 | 67 |
| 2020 Mayo | 21 | 29 | 50 |
| 2020 Abril | 25 | 24 | 49 |
| 2020 Marzo | 29 | 26 | 55 |
| 2020 Febrero | 8 | 14 | 22 |
| 2020 Enero | 0 | 12 | 12 |
| 2019 Diciembre | 0 | 18 | 18 |
| 2019 Noviembre | 0 | 5 | 5 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 0 | 15 | 15 |
| 2019 Agosto | 0 | 10 | 10 |
| 2019 Julio | 0 | 16 | 16 |
| 2019 Junio | 0 | 21 | 21 |
| 2019 Mayo | 0 | 55 | 55 |
| 2019 Abril | 0 | 47 | 47 |
| 2019 Marzo | 0 | 15 | 15 |
| 2019 Febrero | 2 | 14 | 16 |
| 2019 Enero | 3 | 10 | 13 |
| 2018 Diciembre | 3 | 9 | 12 |
| 2018 Noviembre | 2 | 1 | 3 |
| 2018 Octubre | 7 | 2 | 9 |
| 2018 Septiembre | 6 | 3 | 9 |
| 2018 Agosto | 0 | 6 | 6 |
| 2018 Julio | 0 | 8 | 8 |
| 2018 Junio | 0 | 10 | 10 |
| 2018 Mayo | 0 | 10 | 10 |
| 2018 Abril | 0 | 3 | 3 |
| 2018 Marzo | 1 | 2 | 3 |
| 2018 Febrero | 52 | 15 | 67 |
| 2018 Enero | 44 | 12 | 56 |
| 2017 Diciembre | 48 | 11 | 59 |
| 2017 Noviembre | 43 | 13 | 56 |
| 2017 Octubre | 43 | 15 | 58 |
| 2017 Septiembre | 41 | 19 | 60 |
| 2017 Agosto | 52 | 15 | 67 |
| 2017 Julio | 39 | 11 | 50 |
| 2017 Junio | 49 | 30 | 79 |
| 2017 Mayo | 26 | 17 | 43 |
| 2017 Abril | 61 | 25 | 86 |
| 2017 Marzo | 32 | 31 | 63 |
| 2017 Febrero | 18 | 11 | 29 |
| 2017 Enero | 15 | 10 | 25 |
| 2016 Diciembre | 34 | 13 | 47 |
| 2016 Noviembre | 32 | 20 | 52 |
| 2016 Octubre | 23 | 25 | 48 |
| 2016 Septiembre | 0 | 8 | 8 |
| 2016 Agosto | 0 | 6 | 6 |
| 2016 Julio | 5 | 4 | 9 |
| 2016 Junio | 10 | 1 | 11 |
| 2016 Mayo | 12 | 18 | 30 |
| 2016 Abril | 5 | 17 | 22 |
| 2016 Marzo | 4 | 1 | 5 |
| 2016 Febrero | 0 | 2 | 2 |
| 2016 Enero | 0 | 1 | 1 |
| 2015 Diciembre | 0 | 3 | 3 |
| 2015 Noviembre | 0 | 3 | 3 |
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