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1</a>&#41;&#46; Histological study of a biopsied sample from one of the lesions demonstrated an epidermis with erosions and intraepidermal blisters&#44; marked acantholysis&#44; and the typical appearance of a dilapidated brick wall&#46; The patient had been diagnosed with Hailey-Hailey disease and had received multiple treatments with astringents such as copper and zinc sulfate &#40;1&#58;1000&#41;&#44; topical and systemic steroids&#44; topical vitamin D derivatives&#44; topical tacrolimus&#44; and acitretin&#46; Response to treatment had always been partial with a disease-free interval between flares lasting only a few weeks&#46; These shortcomings represented an important limitation for the patient&#46; He agreed to undergo a single session of PDT to see what the response would be and to assess the tolerability of the treatment&#46; First&#44; both underarms were cleaned with physiological saline solution and methyl aminolevulinate &#40;MAL&#41; cream was applied under occlusion for 3<span class="elsevierStyleHsp" style=""></span>hours&#46; The underarms were then irradiated with a red light &#40;Aktilite at 37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; for 7&#46;5 minutes&#46; During the period of exposure&#44; the patient experienced a slight sensation of pain and burning&#44; which was well tolerated&#46; The response on follow-up at 2 weeks was excellent&#58; the erosions had healed&#44; the exudate and erythema had disappeared&#44; and the patient reported an improvement in his quality of life &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Six months later&#44; the patient is still free of lesions and has not undergone any other treatment&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Hailey-Hailey disease or familial benign pemphigus is an autosomal dominant genodermatosis caused by a mutation in the <span class="elsevierStyleItalic">ATP2C1</span> gene&#46; It is characterized by the appearance of vesicles&#44; blisters&#44; and erosions in flexural areas&#44; including the neck and axillas as well as the inframammary and inguinal folds&#46; Typically&#44; patients experience recurrent flares and&#44; occasionally&#44; spontaneous remission&#46; Among the best known precipitating factors are exposure to UV light&#44; sweat&#44; friction&#44; stress&#44; skin infections&#44; and pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Many treatments have been used to control the disease with varying results&#46; Medical treatments include topical and systemic corticosteroids&#44; topical and systemic antibiotics&#44; topical vitamin D analogs&#44; topical 5-fluorouracil&#44; dapsone&#44; psoralen and UV-A light therapy&#44; systemic retinoids&#44; ciclosporin&#44; methotrexate&#44; and oral glycopyrrolate&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;3</span></a> A number of invasive treatments have been attempted&#44; including infiltration with botulinum toxin&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> carbon dioxide laser&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#44;6</span></a> erbium&#58; yttrium aluminium garnet laser&#44; and dermabrasion&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the literature&#44; we found only 2 articles &#40;referring to 5 patients&#41; on Hailey-Hailey disease treated with PDT &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The age of the 5 patients ranged from 28 to 51 years and all but one were women&#46; The time elapsed since diagnosis ranged from 8 months to 24 years&#44; and all 5 patients had undergone prior treatment with topical corticosteroids and a topical vitamin D analog or an antibiotic&#46; Two of the patients had a complete response followed by a disease-free interval of 19 and 25 months&#44; respectively&#59; a further 2 patients showed partial improvement of their lesions&#44; and the remaining patient did not improve&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">7&#44;8</span></a> In the cases reported by Ruiz-Rodriguez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> PDT was well tolerated because lidocaine 1&#37; was administered in the treatment site as a local anesthetic&#46; By contrast&#44; the 3 patients reported by Fern&#225;ndez-Guarinoet al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> experienced pain&#44; erythema and&#47;or edema during and after treatment and none of them wished to undergo another PDT session&#46; Topical anesthetics could interfere with the effectiveness of PDT treatment because they have an alkaline pH that destabilizes the aminolevulinic acid&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> It remains unclear why patients with Hailey-Hailey disease improve with PDT&#44; but the good response is thought to be due to intracellular accumulation of protoporphyrin IX in epidermal keratinocytes&#44; which interferes with structures such as mitochondria&#44; lysosomes&#44; and endoplasmic reticulum&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Providing it is tolerated&#44; PDT may represent an alternative treatment option in cases of Hailey-Hailey disease refractory to first-line therapies&#44; since durable remissions can be achieved that can improve the patient&#39;s quality of life&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous&#44; erosive&#44; and highly exudative plaques with surface crusts in the axillas&#46;</p>"
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                  \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">Reference&nbsp;\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">Age&nbsp;\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&nbsp;\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">Duration of Disease&nbsp;\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 Affected&nbsp;\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">Prior Treatments&nbsp;\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">Disease-Free Interval After PDT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ruiz-Rodr&#237;guez et al&#46;&#44; 2002<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#9792;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&#44; groin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Topical and systemic corticosteroids&#44; topical and systemic antibiotics&#44; dermabrasion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete response&#44; 19 mo&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#9792;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Groin&#44; vulva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Topical and systemic corticosteroids&#44; topical and systemic antibiotics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete response&#44; 25 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fern&#225;ndez Guarino et al&#46;&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#9792;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Topical corticosteroids and vitamin D analogs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No response&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#9794;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Perianal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Corticosteroids&#44; vitamin D analogs&#44; topical immunomodulator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial response&#44; 6 mo&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#9792;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vulva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Corticosteroids&#44; vitamin D analogs&#44; topical immunomodulator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lobato-Berezo&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&#44; neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Copper and zinc sulfate&#44; topical and systemic corticosteroids&#44; vitamin D analogs&#44; topical tacrolimus&#44; acitretin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete response&#44; 6 mo&nbsp;\t\t\t\t\t\t\n
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Case and Research Letters
Refractory Hailey-Hailey Disease That Responded Well to Photodynamic Therapy
Enfermedad de Hailey-Hailey recalcitrante con buena respuesta a terapia fotodinámica
A. Lobato-Berezo
Autor para correspondencia
allobe@hotmail.es

Corresponding author.
, A. Imbernón-Moya, A. Aguilar-Martínez
Departamento de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
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1</a>&#41;&#46; Histological study of a biopsied sample from one of the lesions demonstrated an epidermis with erosions and intraepidermal blisters&#44; marked acantholysis&#44; and the typical appearance of a dilapidated brick wall&#46; The patient had been diagnosed with Hailey-Hailey disease and had received multiple treatments with astringents such as copper and zinc sulfate &#40;1&#58;1000&#41;&#44; topical and systemic steroids&#44; topical vitamin D derivatives&#44; topical tacrolimus&#44; and acitretin&#46; Response to treatment had always been partial with a disease-free interval between flares lasting only a few weeks&#46; These shortcomings represented an important limitation for the patient&#46; He agreed to undergo a single session of PDT to see what the response would be and to assess the tolerability of the treatment&#46; First&#44; both underarms were cleaned with physiological saline solution and methyl aminolevulinate &#40;MAL&#41; cream was applied under occlusion for 3<span class="elsevierStyleHsp" style=""></span>hours&#46; The underarms were then irradiated with a red light &#40;Aktilite at 37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; for 7&#46;5 minutes&#46; During the period of exposure&#44; the patient experienced a slight sensation of pain and burning&#44; which was well tolerated&#46; The response on follow-up at 2 weeks was excellent&#58; the erosions had healed&#44; the exudate and erythema had disappeared&#44; and the patient reported an improvement in his quality of life &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Six months later&#44; the patient is still free of lesions and has not undergone any other treatment&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Hailey-Hailey disease or familial benign pemphigus is an autosomal dominant genodermatosis caused by a mutation in the <span class="elsevierStyleItalic">ATP2C1</span> gene&#46; It is characterized by the appearance of vesicles&#44; blisters&#44; and erosions in flexural areas&#44; including the neck and axillas as well as the inframammary and inguinal folds&#46; Typically&#44; patients experience recurrent flares and&#44; occasionally&#44; spontaneous remission&#46; Among the best known precipitating factors are exposure to UV light&#44; sweat&#44; friction&#44; stress&#44; skin infections&#44; and pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Many treatments have been used to control the disease with varying results&#46; Medical treatments include topical and systemic corticosteroids&#44; topical and systemic antibiotics&#44; topical vitamin D analogs&#44; topical 5-fluorouracil&#44; dapsone&#44; psoralen and UV-A light therapy&#44; systemic retinoids&#44; ciclosporin&#44; methotrexate&#44; and oral glycopyrrolate&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;3</span></a> A number of invasive treatments have been attempted&#44; including infiltration with botulinum toxin&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> carbon dioxide laser&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#44;6</span></a> erbium&#58; yttrium aluminium garnet laser&#44; and dermabrasion&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the literature&#44; we found only 2 articles &#40;referring to 5 patients&#41; on Hailey-Hailey disease treated with PDT &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The age of the 5 patients ranged from 28 to 51 years and all but one were women&#46; The time elapsed since diagnosis ranged from 8 months to 24 years&#44; and all 5 patients had undergone prior treatment with topical corticosteroids and a topical vitamin D analog or an antibiotic&#46; Two of the patients had a complete response followed by a disease-free interval of 19 and 25 months&#44; respectively&#59; a further 2 patients showed partial improvement of their lesions&#44; and the remaining patient did not improve&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">7&#44;8</span></a> In the cases reported by Ruiz-Rodriguez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> PDT was well tolerated because lidocaine 1&#37; was administered in the treatment site as a local anesthetic&#46; By contrast&#44; the 3 patients reported by Fern&#225;ndez-Guarinoet al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> experienced pain&#44; erythema and&#47;or edema during and after treatment and none of them wished to undergo another PDT session&#46; Topical anesthetics could interfere with the effectiveness of PDT treatment because they have an alkaline pH that destabilizes the aminolevulinic acid&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> It remains unclear why patients with Hailey-Hailey disease improve with PDT&#44; 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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\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&nbsp;\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">Duration of Disease&nbsp;\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 Affected&nbsp;\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">Prior Treatments&nbsp;\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">Disease-Free Interval After PDT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ruiz-Rodr&#237;guez et al&#46;&#44; 2002<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#9792;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&#44; groin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Topical and systemic corticosteroids&#44; topical and systemic antibiotics&#44; dermabrasion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete response&#44; 19 mo&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#9792;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Groin&#44; vulva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Topical and systemic corticosteroids&#44; topical and systemic antibiotics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete response&#44; 25 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fern&#225;ndez Guarino et al&#46;&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#9792;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Topical corticosteroids and vitamin D analogs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No response&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#9794;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Perianal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Corticosteroids&#44; vitamin D analogs&#44; topical immunomodulator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial response&#44; 6 mo&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#9792;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vulva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Corticosteroids&#44; vitamin D analogs&#44; topical immunomodulator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lobato-Berezo&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#9794;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axillas&#44; neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Copper and zinc sulfate&#44; topical and systemic corticosteroids&#44; vitamin D analogs&#44; topical tacrolimus&#44; acitretin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete response&#44; 6 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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