Resident's Forum
RF - Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Treatment Update
FR - Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica. Actualización en el manejo terapéutico
A. de Quintana-Sancho
, M. Rubio-Lombraña, O. Guergue Díaz-de-Cerio, A. Barrutia-Borque
Autor para correspondencia
Servicio de Dermatología, Hospital Universitario Cruces, Baracaldo, Vizcaya, Spain
Leído
5512
Vecesse ha leído el artículo
2414
Total PDF
3098
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219016000160" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.05.024" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1198" "copyright" => "AEDV" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2016;107:247-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 930 "formatos" => array:3 [ "EPUB" => 39 "HTML" => 479 "PDF" => 412 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731015002677" "issn" => "00017310" "doi" => "10.1016/j.ad.2015.05.003" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1198" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2016;107:247-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 306 "formatos" => array:3 [ "EPUB" => 4 "HTML" => 208 "PDF" => 94 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Foro de Residentes</span>" "titulo" => "FR - Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica. Actualización en el manejo terapéutico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "248" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "RF - Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Treatment Update" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. de Quintana-Sancho, M. Rubio-Lombraña, O. Guergue Díaz-de-Cerio, A. Barrutia-Borque" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "de Quintana-Sancho" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Rubio-Lombraña" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Guergue Díaz-de-Cerio" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Barrutia-Borque" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219016000160" "doi" => "10.1016/j.adengl.2015.05.024" "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/S1578219016000160?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015002677?idApp=UINPBA000044" "url" => "/00017310/0000010700000003/v1_201603300136/S0001731015002677/v1_201603300136/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219016000172" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.01.014" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1202" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2016;107:249" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 984 "formatos" => array:3 [ "EPUB" => 54 "HTML" => 633 "PDF" => 297 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>" "titulo" => "Generalized Keratosis Lichenoides Chronica" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "249" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Queratosis liquenoide crónica generalizada" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 625 "Ancho" => 890 "Tamanyo" => 182790 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Santesteban-Muruzábal, M. Larrea-García, I. Yanguas-Bayona" "autores" => array:3 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Santesteban-Muruzábal" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Larrea-García" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Yanguas-Bayona" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015002719" "doi" => "10.1016/j.ad.2015.03.014" "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/S0001731015002719?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000172?idApp=UINPBA000044" "url" => "/15782190/0000010700000003/v2_201704010117/S1578219016000172/v2_201704010117/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016000184" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.01.015" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1252" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:245-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 902 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 552 "PDF" => 305 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Lobulated Lesions on the Fingers" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "245" "paginaFinal" => "246" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones lobuladas en los dedos de la mano" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 833 "Ancho" => 1178 "Tamanyo" => 112509 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Toro-Montecinos, A. Plana-Pla, L. Barboza-Guadagnini, C. Rodriguez-Caruncho" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Toro-Montecinos" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Plana-Pla" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Barboza-Guadagnini" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Rodriguez-Caruncho" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015003890" "doi" => "10.1016/j.ad.2015.02.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015003890?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000184?idApp=UINPBA000044" "url" => "/15782190/0000010700000003/v2_201704010117/S1578219016000184/v2_201704010117/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident's Forum</span>" "titulo" => "RF - Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Treatment Update" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "248" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. de Quintana-Sancho, M. Rubio-Lombraña, O. Guergue Díaz-de-Cerio, A. Barrutia-Borque" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "de Quintana-Sancho" "email" => array:1 [ 0 => "adriandeq@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Rubio-Lombraña" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Guergue Díaz-de-Cerio" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Barrutia-Borque" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Cruces, Baracaldo, Vizcaya, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR - Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica. Actualización en el manejo terapéutico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially serious diseases, usually caused by a drug reaction, with a mortality rate of approximately 25%. Optimum treatment is not well established. The only randomized clinical trial, which took several years to complete, showed that thalidomide was not only ineffective but was associated with higher mortality.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Since then, cases have been published of treatment with cyclophosphamide, systemic corticosteroids, plasmapheresis, cyclosporin, intravenous immunoglobulins (IVIGs), and tumor necrosis factor inhibitors (anti-TNF agents). In this summary, we wish to comment on the findings of 2 recently published studies on the management of this disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In 1998, IVIG was reported as an effective therapy in patients with SJS/TEN for the first time.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Since then, the studies published show conflicting results, and it has not been possible to demonstrate a significant improvement in survival among patients treated with IVIG compared to those who receive only supportive care.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> However, a study has shown decreased mortality when IVIG is used at high doses (≥<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>g/kg).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Kirchhof et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> conducted a retrospective study and analyzed the outcomes of treatment with IVIG 1<span class="elsevierStyleHsp" style=""></span>g/kg/d for 3 days or cyclosporin 3-5<span class="elsevierStyleHsp" style=""></span>mg/kg/d for up to a maximum of 7 days. Of the 64 patients with clinical and histologic evidence of SJS/TEN included in the study, 12 received conservative treatment, 35 received IVIG, 15 received cyclosporin, and 2 received both IVIG and cyclosporin. Based on the estimated mortality according to the SCORe of Toxic Epidermal Necrosis (SCORTEN) scale, the authors concluded that those patients who received IVIG had a higher than expected mortality. In contrast, those who received cyclosporin had a lower mortality.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A study conducted by Paradisi et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> included 10 patients whose diagnosis of TEN was based on the presence of blisters and erosions on more than 30% of the body surface area. In addition to the corresponding support measures, patients received a single etanercept dose (50<span class="elsevierStyleHsp" style=""></span>mg subcutaneously) within 6<span class="elsevierStyleHsp" style=""></span>h of hospital admission. All patients responded satisfactorily to treatment and attained complete reepithelization within a mean of 8.5 days (range, 7-20 d). No patient experienced adverse effects attributed to etanercept. To date, the use of etanercept had only been reported in 2 patients with TEN. In addition, isolated cases had been reported of infliximab administration with good response. This is the largest study published to date and demonstrates the beneficial role of anti-TNF agents in patients with TEN. Although this study lacks a control arm, it nevertheless seems reasonable to consider etanercept as a new therapeutic possibility.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Discontinuation of the causative drug and support measures, such as wound dressing, fluid administration, nutritional support, pain management, and prevention and treatment of infections remains the mainstay of treatment. Patients with extensive involvement and/or SCORTEN scores<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>2 should be referred to large burns units.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There is certain controversy regarding management of SJS/TEN, particularly with regards the use of systemic corticosteroids and IVIG. However, these recent studies seem to shed some light on the best approach as they support the use of cyclosporin and open up the possibility of using anti-TNF agents as a promising therapy in what is an extremely serious disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Ethical Responsibilities</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Protection of human and animal subjects</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed are in line with the corresponding ethics committee and the Helsinki Declaration of the World Medical Association.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Confidentiality of data</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have followed their hospital's protocol on the publication of data concerning patients.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors obtained the informed consent of patients and/or subjects mentioned in this article. The informed consent form is located in the archives of the corresponding author.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "xpalclavsec819978" "titulo" => "Keywords" ] 1 => array:2 [ "identificador" => "xpalclavsec819979" "titulo" => "Palabras clave" ] 2 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec819978" "palabras" => array:4 [ 0 => "Stevens-Johnson syndrome" 1 => "Epidermal necrolysis, toxic" 2 => "Cyclosporine" 3 => "Etanercept" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de Quintana-Sancho A, Rubio-Lombraña M, Díaz-de-Cerio OG, Barrutia-Borque A. FR - Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica. Actualización en el manejo terapéutico. Actas Dermosifiliogr. 2016;107:247–248.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomised comparison of thalidomide versus placebo in toxic epidermal necrolysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Wolkenstein" 1 => "J. Latarjet" 2 => "J.C. Roujeau" 3 => "C. Duguet" 4 => "S. Boudeau" 5 => "L. Vaillant" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(98)02197-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1998" "volumen" => "352" "paginaInicial" => "1586" "paginaFinal" => "1589" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9843104" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Viard" 1 => "P. Wehrli" 2 => "R. Bullani" 3 => "P. Schneider" 4 => "N. Holler" 5 => "D. Salomon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Science" "fecha" => "1998" "volumen" => "282" "paginaInicial" => "490" "paginaFinal" => "493" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9774279" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: A retrospective study on patients included in the prospective EuroSCAR study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Schneck" 1 => "J.P. Fagot" 2 => "P. Sekula" 3 => "B. Sassolas" 4 => "J.C. Roujeau" 5 => "M. Mockenhaupt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2007.08.039" "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2008" "volumen" => "58" "paginaInicial" => "33" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17919775" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0939475314001094" "estado" => "S300" "issn" => "09394753" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The efficacy of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis: A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y.C. Huang" 1 => "Y.C. Li" 2 => "T.J. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2012.10965.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2012" "volumen" => "167" "paginaInicial" => "424" "paginaFinal" => "432" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22458671" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retrospective review of Stevens-Johnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.G. Kirchhof" 1 => "M.A. Miliszewski" 2 => "S. Sikora" 3 => "A. Papp" 4 => "J.P. Dutz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2014.07.016" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2014" "volumen" => "71" "paginaInicial" => "941" "paginaFinal" => "947" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25087214" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etanercept therapy for toxic epidermal necrolysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Paradisi" 1 => "D. Abeni" 2 => "F. Bergamo" 3 => "F. Ricci" 4 => "D. Didona" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2014.04.044" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2014" "volumen" => "71" "paginaInicial" => "278" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24928706" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000003/v2_201704010117/S1578219016000160/v2_201704010117/en/main.assets" "Apartado" => array:4 [ "identificador" => "34945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Resident's Forum" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000003/v2_201704010117/S1578219016000160/v2_201704010117/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000160?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 7 | 14 |
| 2024 Octubre | 70 | 53 | 123 |
| 2024 Septiembre | 71 | 36 | 107 |
| 2024 Agosto | 108 | 63 | 171 |
| 2024 Julio | 103 | 45 | 148 |
| 2024 Junio | 97 | 59 | 156 |
| 2024 Mayo | 68 | 55 | 123 |
| 2024 Abril | 71 | 34 | 105 |
| 2024 Marzo | 59 | 38 | 97 |
| 2024 Febrero | 72 | 44 | 116 |
| 2024 Enero | 58 | 34 | 92 |
| 2023 Diciembre | 66 | 41 | 107 |
| 2023 Noviembre | 98 | 44 | 142 |
| 2023 Octubre | 98 | 35 | 133 |
| 2023 Septiembre | 47 | 38 | 85 |
| 2023 Agosto | 45 | 21 | 66 |
| 2023 Julio | 48 | 55 | 103 |
| 2023 Junio | 48 | 24 | 72 |
| 2023 Mayo | 57 | 34 | 91 |
| 2023 Abril | 32 | 33 | 65 |
| 2023 Marzo | 35 | 30 | 65 |
| 2023 Febrero | 39 | 34 | 73 |
| 2023 Enero | 32 | 48 | 80 |
| 2022 Diciembre | 52 | 46 | 98 |
| 2022 Noviembre | 28 | 28 | 56 |
| 2022 Octubre | 29 | 26 | 55 |
| 2022 Septiembre | 44 | 44 | 88 |
| 2022 Agosto | 26 | 37 | 63 |
| 2022 Julio | 20 | 41 | 61 |
| 2022 Junio | 19 | 35 | 54 |
| 2022 Mayo | 28 | 55 | 83 |
| 2022 Abril | 52 | 30 | 82 |
| 2022 Marzo | 39 | 44 | 83 |
| 2022 Febrero | 30 | 30 | 60 |
| 2022 Enero | 32 | 37 | 69 |
| 2021 Diciembre | 18 | 36 | 54 |
| 2021 Noviembre | 29 | 40 | 69 |
| 2021 Octubre | 56 | 52 | 108 |
| 2021 Septiembre | 33 | 45 | 78 |
| 2021 Agosto | 30 | 32 | 62 |
| 2021 Julio | 29 | 29 | 58 |
| 2021 Junio | 45 | 33 | 78 |
| 2021 Mayo | 49 | 49 | 98 |
| 2021 Abril | 74 | 35 | 109 |
| 2021 Marzo | 55 | 33 | 88 |
| 2021 Febrero | 58 | 39 | 97 |
| 2021 Enero | 39 | 20 | 59 |
| 2020 Diciembre | 41 | 17 | 58 |
| 2020 Noviembre | 25 | 22 | 47 |
| 2020 Octubre | 32 | 23 | 55 |
| 2020 Septiembre | 23 | 19 | 42 |
| 2020 Agosto | 26 | 19 | 45 |
| 2020 Julio | 19 | 12 | 31 |
| 2020 Junio | 22 | 30 | 52 |
| 2020 Mayo | 28 | 18 | 46 |
| 2020 Abril | 30 | 22 | 52 |
| 2020 Marzo | 28 | 19 | 47 |
| 2020 Febrero | 3 | 0 | 3 |
| 2019 Diciembre | 2 | 2 | 4 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Julio | 0 | 2 | 2 |
| 2019 Junio | 2 | 3 | 5 |
| 2019 Mayo | 0 | 22 | 22 |
| 2019 Abril | 0 | 1 | 1 |
| 2019 Marzo | 2 | 3 | 5 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Agosto | 0 | 7 | 7 |
| 2018 Julio | 0 | 10 | 10 |
| 2018 Junio | 0 | 2 | 2 |
| 2018 Mayo | 0 | 8 | 8 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 0 | 3 | 3 |
| 2018 Febrero | 13 | 13 | 26 |
| 2018 Enero | 44 | 14 | 58 |
| 2017 Diciembre | 38 | 15 | 53 |
| 2017 Noviembre | 25 | 13 | 38 |
| 2017 Octubre | 26 | 11 | 37 |
| 2017 Septiembre | 24 | 13 | 37 |
| 2017 Agosto | 23 | 17 | 40 |
| 2017 Julio | 20 | 13 | 33 |
| 2017 Junio | 28 | 23 | 51 |
| 2017 Mayo | 34 | 32 | 66 |
| 2017 Abril | 32 | 18 | 50 |
| 2017 Marzo | 21 | 38 | 59 |
| 2017 Febrero | 24 | 21 | 45 |
| 2017 Enero | 23 | 16 | 39 |
| 2016 Diciembre | 19 | 22 | 41 |
| 2016 Noviembre | 29 | 19 | 48 |
| 2016 Octubre | 31 | 25 | 56 |
| 2016 Septiembre | 0 | 4 | 4 |
| 2016 Agosto | 1 | 4 | 5 |
| 2016 Julio | 2 | 11 | 13 |
| 2016 Junio | 0 | 5 | 5 |
Mostrar todo
