Case for Diagnosis
Nodules and Erythematous Papules on the Lower Legs and Knees
Nódulos y pápulas eritematosas en piernas y rodillas
B. Lozano-Masdemont
, L. Gómez-Recuero-Muñoz, O. Baniandrés-Rodríguez
Autor para correspondencia
Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Leído
8486
Vecesse ha leído el artículo
1694
Total PDF
6792
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219016300233" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.03.009" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1302" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:423-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 933 "formatos" => array:3 [ "EPUB" => 57 "HTML" => 739 "PDF" => 137 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731015004986" "issn" => "00017310" "doi" => "10.1016/j.ad.2015.10.008" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1302" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:423-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 619 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 577 "PDF" => 40 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Casos para el diagnóstico</span>" "titulo" => "Nódulos y pápulas eritematosas en piernas y rodillas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "423" "paginaFinal" => "424" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Nodules and Erythematous Papules on the Lower Legs and Knees" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 475 "Ancho" => 600 "Tamanyo" => 47576 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Lozano-Masdemont, L. Gómez-Recuero-Muñoz, O. Baniandrés-Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Lozano-Masdemont" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Gómez-Recuero-Muñoz" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Baniandrés-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219016300233" "doi" => "10.1016/j.adengl.2016.03.009" "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/S1578219016300233?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015004986?idApp=UINPBA000044" "url" => "/00017310/0000010700000005/v1_201605260143/S0001731015004986/v1_201605260143/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219016300245" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.03.010" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1363" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:425-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 778 "formatos" => array:3 [ "EPUB" => 69 "HTML" => 551 "PDF" => 158 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Videos of Surgical Procedures in Dermatology</span>" "titulo" => "Axillary Sentinel Lymph Node Biopsy: Video of the Surgical Procedure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "425" "paginaFinal" => "426" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Biopsia selectiva del ganglio centinela de localización axilar. Video quirúrgico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Moreno-Ramírez, L. Ferrándiz, T. Ojeda-Vila, F.M.I. Mendonça, P. de la Riva" "autores" => array:5 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Moreno-Ramírez" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Ferrándiz" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Ojeda-Vila" ] 3 => array:2 [ "nombre" => "F.M.I." "apellidos" => "Mendonça" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "de la Riva" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731016000776" "doi" => "10.1016/j.ad.2016.02.002" "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/S0001731016000776?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300245?idApp=UINPBA000044" "url" => "/15782190/0000010700000005/v2_201703310310/S1578219016300245/v2_201703310310/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016300221" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.03.008" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "1294" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:421-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 675 "formatos" => array:3 [ "EPUB" => 66 "HTML" => 489 "PDF" => 120 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cases for Diagnosis</span>" "titulo" => "Pigmented Vascular Tumor in Skin Not Exposed to Sunlight" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "421" "paginaFinal" => "422" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión tumoral pigmentada y vascular en piel no fotoexpuesta" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 500 "Ancho" => 669 "Tamanyo" => 131313 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×40.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Guebenlian, J. Magliano, C. Agorio" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Guebenlian" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Magliano" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Agorio" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015004901" "doi" => "10.1016/j.ad.2015.08.008" "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/S0001731015004901?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300221?idApp=UINPBA000044" "url" => "/15782190/0000010700000005/v2_201703310310/S1578219016300221/v2_201703310310/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Nodules and Erythematous Papules on the Lower Legs and Knees" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "423" "paginaFinal" => "424" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "B. Lozano-Masdemont, L. Gómez-Recuero-Muñoz, O. Baniandrés-Rodríguez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Lozano-Masdemont" "email" => array:1 [ 0 => "belenmasdemont@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Gómez-Recuero-Muñoz" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Baniandrés-Rodríguez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulos y pápulas eritematosas en piernas y rodillas" ] ] "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" => 475 "Ancho" => 600 "Tamanyo" => 48132 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 58-year-old woman with a history of chronic obstructive pulmonary disease presented with cutaneous lesions that had appeared on both legs and knees over the previous 7 days. The leg lesions were painful, but those on her knees were asymptomatic and had only come to her attention while she was examining the other lesions. She reported no trauma to the area or subcutaneous injections. There were no digestive or respiratory symptoms, fever, or joint pain. The physical examination showed 15 to 20 erythematous nodules measuring 20 to 40<span class="elsevierStyleHsp" style=""></span>mm on both legs and knees; the lesions were largely located on the anterior aspects (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesions on the knees were flat, linearly arranged, red-orange papules measuring 2 to 3<span class="elsevierStyleHsp" style=""></span>mm.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Histopathology</span><p id="par0010" class="elsevierStylePara elsevierViewall">Histologic examination showed an inflammatory infiltrate of histiocytes in the hypodermis for one of the nodules (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and granulomas in the dermis for one of the papules (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Ziehl-Neelsen staining was negative in both cases.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">Normal results were obtained for complete blood count, liver function, angiotensin converting enzyme, C reactive protein, and erythrocyte sedimentation rate. Cultures for bacteria, mycobacteria, and fungi were negative for both lesions, as was the Mantoux tuberculin skin test. The chest radiograph showed findings consistent with the patient's underlying lung disease. The eye study was normal.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Sarcoidosis: papular sarcoidosis of the knees and erythema nodosum (EN).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was prescribed ibuprofen 600<span class="elsevierStyleHsp" style=""></span>mg/8<span class="elsevierStyleHsp" style=""></span>h and rest with leg elevation. The knee and leg lesions resolved within 8 weeks. No involvement of other organs was observed in a year of clinical follow-up.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The cutaneous manifestations of sarcoidosis are classified as nonspecific (e.g., EN), or specific (granulomatous).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Papular sarcoidosis of the knees is considered to be an intermediate form of papular sarcoidosis and scar sarcoidosis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It consists of small brownish-red papules on both knees that are frequently arranged linearly and have a lichenoid appearance.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Histology shows noncaseating granulomas with scarce lymphocytes in the papillary dermis, and on occasions, the hypodermis.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> The differential diagnosis should include other entities with noncaseating granulomas, i.e., certain types of tuberculosis (with positive Ziehl-Neelsen staining), tuberculoid leprosy (with nerve involvement), Crohn disease (diffuse, with perivascular lymphocytic cuffing and frequent eosinophils and ulceration), and foreign body granuloma. Foreign material is frequently detected under polarized light microscopy,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> but this does not rule out a diagnosis of sarcoidoisis.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4</span></a> This material was not observed in our case. In papular sarcoidosis of the knees, the presence of linear papules together with the absence of a histologic scar and history of trauma suggests that the granulomas could be the result of a reaction to foreign bodies following a small penetrating injury rather than a scar tissue reaction.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">When viewed under low magnification, EN can be confused with other entities that predominantly affect the adipose septa, namely, leukocytoclastic vasculitis (characterized by venules with fibrinoid necrosis, neutrophils within vessel walls, and nuclear dust), superficial thrombophlebitis (inflammation around a thrombosed vein, without involvement of the fat lobules), and polyarteritis nodosum (involvement of muscle arteries, also in the dermis). Marcoval et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> found EN in 11 of 13 patients with papular sarcoidosis of the knees and considered this coexistence to be a key factor for distinguishing this variant of sarcoidosis from other conditions associated with EN. The 13 cases of papular sarcoidosis reported by Marcoval et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> and the case reported by Choi et al.<span class="elsevierStyleSup">15</span> were all systemic, unlike our case. Papular sarcoidosis of the knees can also occur in association with nodules other than EN nodules, as demonstrated by the case reported by Kondo and Nishii<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> in which a patient, diagnosed with subcutaneous sarcoidosis, developed clinically different lesions under several plaques. Maculopapular lesions tend to be associated with acute forms of sarcoidosis,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> and papular sarcoidosis of the knees also appears to be more common in these acute forms, which are associated with a better prognosis.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3,5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">We have described a new case of papular sarcoidosis of the knees and EN with, to date, exclusive cutaneous involvement, providing further support of the good prognosis associated with this condition. Nevertheless, it is advisable to monitor patients to check for future outbreaks and the involvement of other organs.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Histopathology" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => 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: Lozano-Masdemont B, Gómez-Recuero-Muñoz L, Baniandrés-Rodríguez O. Nódulos y pápulas eritematosas en piernas y rodillas. Actas Dermosifiliogr. 2016;107:423–424.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 475 "Ancho" => 600 "Tamanyo" => 48132 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 450 "Ancho" => 600 "Tamanyo" => 133510 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification x10.</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" => 796 "Ancho" => 600 "Tamanyo" => 203977 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification x10.</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" => "Sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.C. English 3rd" 1 => "P.J. Patel" 2 => "K.E. Greer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2001.114596" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2001" "volumen" => "44" "paginaInicial" => "725" "paginaFinal" => "743" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11312418" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Papular sarcoidosis of the knees: A clue for the diagnosis of erythema nodosum-associated sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Marcoval" 1 => "A. Moreno" 2 => "J. Mañá" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2003.490" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2003" "volumen" => "49" "paginaInicial" => "75" "paginaFinal" => "78" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12833012" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis with both plaques and subcutaneous nodules associated with combination therapy with Peginterferon α-2a and ribavirin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Kondo" 1 => "M. Nishii" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2011/741293" "Revista" => array:5 [ "tituloSerie" => "Case Rep Dermatol Med" "fecha" => "2011" "volumen" => "2011" "paginaInicial" => "741293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23198179" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Foreign bodies in granulomatous cutaneous lesions of patients with systemic sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Marcoval" 1 => "J. Mañá" 2 => "A. Moreno" 3 => "I. Gallego" 4 => "Y. Fortuño" 5 => "J. Peyrí" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2001" "volumen" => "137" "paginaInicial" => "427" "paginaFinal" => "430" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11295921" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Papular sarcoidosis limited to the knees: A clue for systemic sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.J. Choi" 1 => "S.H. Oh" 2 => "S.E. Chang" 3 => "K.C. Moon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2005.02610.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2006" "volumen" => "45" "paginaInicial" => "169" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16445514" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous involvement in sarcoidosis. Relationship to systemic disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Mañá" 1 => "J. Marcoval" 2 => "J. Graells" 3 => "A. Salazar" 4 => "J. Peyrí" 5 => "R. Pujol" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1997" "volumen" => "133" "paginaInicial" => "882" "paginaFinal" => "888" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9236527" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000005/v2_201703310310/S1578219016300233/v2_201703310310/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000005/v2_201703310310/S1578219016300233/v2_201703310310/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300233?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 5 | 12 |
| 2024 Octubre | 178 | 37 | 215 |
| 2024 Septiembre | 188 | 20 | 208 |
| 2024 Agosto | 245 | 46 | 291 |
| 2024 Julio | 198 | 27 | 225 |
| 2024 Junio | 192 | 22 | 214 |
| 2024 Mayo | 166 | 31 | 197 |
| 2024 Abril | 169 | 27 | 196 |
| 2024 Marzo | 159 | 27 | 186 |
| 2024 Febrero | 196 | 33 | 229 |
| 2024 Enero | 188 | 34 | 222 |
| 2023 Diciembre | 157 | 15 | 172 |
| 2023 Noviembre | 161 | 36 | 197 |
| 2023 Octubre | 152 | 31 | 183 |
| 2023 Septiembre | 122 | 31 | 153 |
| 2023 Agosto | 108 | 13 | 121 |
| 2023 Julio | 97 | 33 | 130 |
| 2023 Junio | 110 | 19 | 129 |
| 2023 Mayo | 189 | 24 | 213 |
| 2023 Abril | 120 | 17 | 137 |
| 2023 Marzo | 90 | 22 | 112 |
| 2023 Febrero | 85 | 22 | 107 |
| 2023 Enero | 100 | 24 | 124 |
| 2022 Diciembre | 93 | 43 | 136 |
| 2022 Noviembre | 57 | 28 | 85 |
| 2022 Octubre | 60 | 27 | 87 |
| 2022 Septiembre | 66 | 35 | 101 |
| 2022 Agosto | 51 | 30 | 81 |
| 2022 Julio | 61 | 32 | 93 |
| 2022 Junio | 50 | 25 | 75 |
| 2022 Mayo | 100 | 30 | 130 |
| 2022 Abril | 105 | 28 | 133 |
| 2022 Marzo | 87 | 36 | 123 |
| 2022 Febrero | 90 | 24 | 114 |
| 2022 Enero | 96 | 54 | 150 |
| 2021 Diciembre | 115 | 42 | 157 |
| 2021 Noviembre | 119 | 48 | 167 |
| 2021 Octubre | 113 | 42 | 155 |
| 2021 Septiembre | 81 | 44 | 125 |
| 2021 Agosto | 62 | 18 | 80 |
| 2021 Julio | 64 | 25 | 89 |
| 2021 Junio | 81 | 20 | 101 |
| 2021 Mayo | 79 | 34 | 113 |
| 2021 Abril | 240 | 58 | 298 |
| 2021 Marzo | 151 | 17 | 168 |
| 2021 Febrero | 113 | 30 | 143 |
| 2021 Enero | 63 | 20 | 83 |
| 2020 Diciembre | 65 | 16 | 81 |
| 2020 Noviembre | 57 | 21 | 78 |
| 2020 Octubre | 45 | 22 | 67 |
| 2020 Septiembre | 56 | 5 | 61 |
| 2020 Agosto | 73 | 17 | 90 |
| 2020 Julio | 44 | 12 | 56 |
| 2020 Junio | 51 | 27 | 78 |
| 2020 Mayo | 27 | 15 | 42 |
| 2020 Abril | 32 | 21 | 53 |
| 2020 Marzo | 24 | 14 | 38 |
| 2020 Febrero | 5 | 1 | 6 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 3 | 0 | 3 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 5 | 0 | 5 |
| 2019 Abril | 2 | 2 | 4 |
| 2019 Marzo | 2 | 3 | 5 |
| 2019 Febrero | 1 | 0 | 1 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Febrero | 54 | 3 | 57 |
| 2018 Enero | 60 | 6 | 66 |
| 2017 Diciembre | 68 | 8 | 76 |
| 2017 Noviembre | 54 | 4 | 58 |
| 2017 Octubre | 57 | 4 | 61 |
| 2017 Septiembre | 51 | 6 | 57 |
| 2017 Agosto | 50 | 5 | 55 |
| 2017 Julio | 28 | 6 | 34 |
| 2017 Junio | 40 | 8 | 48 |
| 2017 Mayo | 37 | 4 | 41 |
| 2017 Abril | 29 | 5 | 34 |
| 2017 Marzo | 28 | 5 | 33 |
| 2017 Febrero | 22 | 4 | 26 |
| 2017 Enero | 25 | 3 | 28 |
| 2016 Diciembre | 31 | 15 | 46 |
| 2016 Noviembre | 35 | 17 | 52 |
| 2016 Octubre | 23 | 26 | 49 |
| 2016 Septiembre | 0 | 1 | 1 |
| 2016 Mayo | 0 | 2 | 2 |
Mostrar todo
