Case and Research Letters
Acropigmentation of the Dorsum of the Hands From Preparing Mojitos: A Lime-Induced Phytophotodermatosis
Acropigmentación dorsal por elaboración de mojitos: una fitofotodermatosis por lima
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Galvañ-Pérez del Pulgar, M. Linares-Barrios, J.I. Galvañ-Pozo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.I." "apellidos" => "Galvañ-Pérez del Pulgar" "email" => array:1 [ 0 => "galvanderma@telefonica.net" ] "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" => "M." "apellidos" => "Linares-Barrios" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "J.I." "apellidos" => "Galvañ-Pozo" "sufijo" => "Jr." "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "DERMACHAT (Grupo Español de Consenso <span class="elsevierStyleItalic">on-line</span> en Dermatología), Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universidad de Szeged, Szeged, Csongrád, Hungría" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acropigmentación dorsal por elaboración de mojitos: una fitofotodermatosis por lima" ] ] "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" => 911 "Ancho" => 1000 "Tamanyo" => 194235 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Asymptomatic, homogeneous hyperpigmentation that developed on the dorsum of the thumbs of both hands of a patient several days after preparing mojitos at a beach party.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Phytophotodermatitis was described in 1942 by Klaber<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> as a skin reaction to exposure to sunlight after previous contact with plants. It is caused by a phototoxic reaction to furocoumarins and anthraquinone derivatives. The plant species that most commonly induces this type of reaction is celery (family Umbelliferae), followed by lime and lemon (family, Rutaceae).</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a series of 9 patients with similar clinical manifestations consisting of irregular homogeneous pigmentation on the dorsum of the hands (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The epidemiological characteristics of the patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Patients were aged between 14 and 41 years (mean [SD], 25.5 [9.8] years). The lesions were asymptomatic and there were no signs of eczema. A common finding in the history of all patients was the preparation of mojitos, with an interval of 7 to 14 days in the majority of cases between exposure and onset of the lesions. A curious finding was that none of the patients associated the onset of their lesions with the preparation of the mixture, and they were all surprised on being asked if they had prepared this drink in previous days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We propose the term “dorsal acropigmentation secondary to mojito preparation” to define a variant of occupational phytophotodermatitis or phototoxicity on the dorsum of the hands (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) of waiters who prepare cocktails with lime, such as mojitos. This cocktail, ever more popular in Spain, is prepared with rum, sparkling water, mint, sugar, and lime. As this is not an immune reaction, no previous sensitization is required and anyone can be affected.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Lime-juice–induced phytophotodermatitis is well-known. This fruit, which belongs to the Rutaceae family, contains photosensitizing compounds, the main ones being bergapten and psoralen,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> with highest content in the skin of the fruit.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> The mechanism of phototoxicity observed with these furocoumarins has been described in detail. Typically, lime induces a phytophotodermatitis that presents acutely with erythema and the formation of vesicles at 12-36<span class="elsevierStyleHsp" style=""></span>hours after exposure of the psoralen to UV radiation and is occasionally painful. The acute phase usually produces hyperpigmentation, depending on the case, but scarring is very rare. Onset of the dermatitis varies between hours and days after contact with the lime contained in the mojito and exposure to the sun. The cause of pigmentation may be melanocyte stimulation or a mechanism secondary to melanocyte damage that induces pigment incontinence.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Symptomatic treatment is sufficient in most cases.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Some cases of lime-induced phytophotodermatitis have been associated with the custom of using lime when drinking certain types of Mexican beers.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> The fruit is used in cooking, though recently it has become very popular as an ingredient in certain cocktails, such as the mojito.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> In our patients, lime was the etiological agent of this phytophotodermatitis in amateur or professional bar staff who were exposed to sunlight after preparing mojitos, a Cuban drink invented during the era of Prohibition in the United States, when those who wanted to drink alcohol legally had to travel out of the country; Cuba became one of the favorite destinations.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The differential diagnosis and the medical history of these types of lesion should rule out contact with figs, lemons, geraniums, and St. John's wort, as other causes of phytophotodermatitis, and it is important to determine whether the person is involved in the preparation of mojitos, in an amateur or a professional setting. It must not be forgotten that, because of the polymorphism of this type of phototoxicity, there are numerous differential diagnoses, including Berloque dermatitis due to oil of bergamot contained in perfumes, frictional dermatitis, and even sexual abuse.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6,7</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:2 [ "identificador" => "xack276185" "titulo" => "Acknowledgments" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Galvañ-Pérez del Pulgar JI, Linares-Barrios M, Galvañ-Pozo JI. Acropigmentación dorsal por elaboración de mojitos: una fitofotodermatosis por lima. Actas Dermosifiliogr. 2016;107:253–255.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 911 "Ancho" => 1000 "Tamanyo" => 194235 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Asymptomatic, homogeneous hyperpigmentation that developed on the dorsum of the thumbs of both hands of a patient several days after preparing mojitos at a beach party.</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" => 1334 "Ancho" => 1000 "Tamanyo" => 242913 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Irregular hyperpigmentation that developed on the dorsum of both hands of a patient 3 days after serving mojitos at a wedding and followed by intense sunlight exposure in adjacent gardens.</p>" ] ] 2 => 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">Patient No. \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">Age \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">Past History \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">Professional Preparation of Mojitos \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 Interval Between Exposure and the Onset of the Manifestations \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">1 \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">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 d \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">2 \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">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dust mite allergy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 d \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">3 \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">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Peach allergy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 d \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">4 \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">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dust mite allergy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 d \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">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 d \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">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 d \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">7 \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">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 d \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">8 \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">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 d \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">9 \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">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 d \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1384185.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epidemiological Characteristics of the Patients With Dorsal Acropigmentation Secondary to Mojito Preparation.</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" => "Phytophotodermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.E. Klaber" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1942" "volumen" => "54" "paginaInicial" => "193" "paginaFinal" => "211" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phototoxic coumarins in limes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.N. Nigg" 1 => "H.E. Nordby" 2 => "R.C. Beier" 3 => "A. Dillman" 4 => "C. Macías" 5 => "R.C. Hansen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Food Chem Toxicol." "fecha" => "1993" "volumen" => "31" "paginaInicial" => "331" "paginaFinal" => "335" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8505017" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bullous phytophotodermatitis associated with high natural concentrations of furanocoumarins in limes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.M. Wagner" 1 => "J.J. Wu" 2 => "R.C. Hansen" 3 => "H.N. Nigg" 4 => "R.C. Beiere" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Contact Dermat" "fecha" => "2002" "volumen" => "13" "paginaInicial" => "10" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11887098" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mexican beer dermatitis: A unique variant of lime phytophotodermatitis attributable to contemporary beer-drinking practices" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.L. Flugman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2010.297" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2010" "volumen" => "146" "paginaInicial" => "1194" "paginaFinal" => "1195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956675" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lime, beer and phytophotodermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.L. Schmutz" 1 => "P. Trechot" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annder.2011.05.012" "Revista" => array:5 [ "tituloSerie" => "Ann Dermatol Venereol" "fecha" => "2012" "volumen" => "139" "paginaInicial" => "81" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22225753" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phytophotodermatitis simulating child abuse" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Coffman" 1 => "W.T. Boyce" 2 => "R.C. Hansen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Dis Child" "fecha" => "1985" "volumen" => "139" "paginaInicial" => "239" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3976604" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phytophotodermatitis due to puncture from lime tree thorn" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.M. Roth" 1 => "E.H. Levin" 2 => "D.J. Schwartz Ah Roth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SMJ.0b013e31803170e8" "Revista" => array:6 [ "tituloSerie" => "South Med J" "fecha" => "2007" "volumen" => "100" "paginaInicial" => "544" "paginaFinal" => "545" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17539046" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack276185" "titulo" => "Acknowledgments" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">We would like to thank Drs. Russo, Azaña, Martín Gorgojo, Taberner, Nieto, and Jiménez Gallo, and all the other members of the DERMACHAT Group for their help in the preparation of this article.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000003/v2_201704010117/S1578219016000305/v2_201704010117/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/15782190/0000010700000003/v2_201704010117/S1578219016000305/v2_201704010117/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000305?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 33 | 5 | 38 |
| 2024 Octubre | 229 | 62 | 291 |
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| 2024 Marzo | 299 | 34 | 333 |
| 2024 Febrero | 221 | 32 | 253 |
| 2024 Enero | 296 | 37 | 333 |
| 2023 Diciembre | 352 | 31 | 383 |
| 2023 Noviembre | 374 | 112 | 486 |
| 2023 Octubre | 400 | 37 | 437 |
| 2023 Septiembre | 395 | 39 | 434 |
| 2023 Agosto | 485 | 34 | 519 |
| 2023 Julio | 525 | 59 | 584 |
| 2023 Junio | 565 | 29 | 594 |
| 2023 Mayo | 310 | 43 | 353 |
| 2023 Abril | 316 | 33 | 349 |
| 2023 Marzo | 410 | 46 | 456 |
| 2023 Febrero | 342 | 23 | 365 |
| 2023 Enero | 250 | 42 | 292 |
| 2022 Diciembre | 205 | 54 | 259 |
| 2022 Noviembre | 167 | 33 | 200 |
| 2022 Octubre | 167 | 36 | 203 |
| 2022 Septiembre | 174 | 57 | 231 |
| 2022 Agosto | 160 | 37 | 197 |
| 2022 Julio | 136 | 37 | 173 |
| 2022 Junio | 167 | 23 | 190 |
| 2022 Mayo | 248 | 48 | 296 |
| 2022 Abril | 313 | 29 | 342 |
| 2022 Marzo | 335 | 43 | 378 |
| 2022 Febrero | 288 | 26 | 314 |
| 2022 Enero | 296 | 35 | 331 |
| 2021 Diciembre | 192 | 40 | 232 |
| 2021 Noviembre | 183 | 43 | 226 |
| 2021 Octubre | 220 | 64 | 284 |
| 2021 Septiembre | 226 | 45 | 271 |
| 2021 Agosto | 338 | 44 | 382 |
| 2021 Julio | 336 | 37 | 373 |
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| 2021 Mayo | 284 | 50 | 334 |
| 2021 Abril | 541 | 60 | 601 |
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| 2021 Febrero | 166 | 40 | 206 |
| 2021 Enero | 111 | 30 | 141 |
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| 2020 Noviembre | 83 | 27 | 110 |
| 2020 Octubre | 102 | 41 | 143 |
| 2020 Septiembre | 153 | 19 | 172 |
| 2020 Agosto | 144 | 23 | 167 |
| 2020 Julio | 132 | 31 | 163 |
| 2020 Junio | 126 | 32 | 158 |
| 2020 Mayo | 75 | 32 | 107 |
| 2020 Abril | 30 | 15 | 45 |
| 2020 Marzo | 27 | 24 | 51 |
| 2020 Febrero | 2 | 4 | 6 |
| 2020 Enero | 4 | 1 | 5 |
| 2019 Diciembre | 7 | 3 | 10 |
| 2019 Noviembre | 4 | 5 | 9 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 4 | 20 | 24 |
| 2019 Agosto | 4 | 2 | 6 |
| 2019 Julio | 5 | 9 | 14 |
| 2019 Junio | 7 | 10 | 17 |
| 2019 Mayo | 5 | 16 | 21 |
| 2019 Abril | 2 | 1 | 3 |
| 2019 Marzo | 4 | 4 | 8 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 5 | 0 | 5 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Febrero | 170 | 3 | 173 |
| 2018 Enero | 181 | 12 | 193 |
| 2017 Diciembre | 142 | 11 | 153 |
| 2017 Noviembre | 96 | 8 | 104 |
| 2017 Octubre | 106 | 7 | 113 |
| 2017 Septiembre | 146 | 5 | 151 |
| 2017 Agosto | 160 | 6 | 166 |
| 2017 Julio | 182 | 11 | 193 |
| 2017 Junio | 83 | 9 | 92 |
| 2017 Mayo | 45 | 7 | 52 |
| 2017 Abril | 23 | 10 | 33 |
| 2017 Marzo | 32 | 11 | 43 |
| 2017 Febrero | 98 | 11 | 109 |
| 2017 Enero | 25 | 8 | 33 |
| 2016 Diciembre | 40 | 26 | 66 |
| 2016 Noviembre | 33 | 14 | 47 |
| 2016 Octubre | 24 | 21 | 45 |
| 2016 Agosto | 1 | 1 | 2 |
| 2016 Junio | 0 | 2 | 2 |
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