Case and Research Letter
Idiopathic Facial Aseptic Granuloma: Usefulness of Cutaneous Ultrasound
Granuloma aséptico facial idiopático. Utilidad de la ecografía cutánea
I. Vázquez-Osorio
, C.C. Álvarez-Cuesta, L. Rodríguez-González, E. Rodríguez-Díaz
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Servicio de Dermatología, Hospital Universitario de Cabueñes, Gijón (Asturias), España
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Utilidad de la ecografía cutánea" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "266" "paginaFinal" => "268" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Idiopathic facial aseptic granuloma: Usefulness of cutaneous ultrasound" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 686 "Ancho" => 950 "Tamanyo" => 76500 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio ultrasonográfico del nódulo de la mejilla izquierda. 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Vázquez-Osorio, C.C. Álvarez-Cuesta, L. Rodríguez-González, E. Rodríguez-Díaz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Vázquez-Osorio" "email" => array:1 [ 0 => "rogivaos@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C.C." "apellidos" => "Álvarez-Cuesta" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Rodríguez-González" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Rodríguez-Díaz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Cabueñes, Gijón (Asturias), España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Granuloma aséptico facial idiopático. Utilidad de la ecografía cutánea" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 686 "Ancho" => 950 "Tamanyo" => 77456 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ultrasound study of the nodule in the left cheek showing a well-defined oval hypoechoic dermal lesion containing no calcium deposits.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Idiopathic facial aseptic granuloma (IFAG) is a benign condition that affects children. It was first described in 1999 and named pyodermite froide du visage, due to its similarity with an abscess with few inflammatory signs.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Subsequently, in 2001, Roul et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> gave it its current name. It is characterized by the appearance of 1 or several asymptomatic erythematous-violaceous nodules that arise in the cheeks, with no predisposing factors.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> We present a case of IFAG, paying particular attention to the ultrasound findings that, associated with compatible clinical manifestations, allow us to reach a correct diagnosis without resorting to unnecessary procedures.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a healthy, 2-year-old boy who was seen for 2 asymptomatic facial lesions that had arisen 4 months earlier. Physical examination revealed 2 relatively firm, painless erythematous-violaceous nodules in the left cheek and right lower eyelid, measuring respectively 1<span class="elsevierStyleHsp" style=""></span>cm and 3<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The nodules did not fluctuate. There were no palpable locoregional lymph nodes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The parents did not report bleeding, ulceration or drainage of purulent fluid, and there was no history of insect bite or trauma. At another center, cultures performed for bacteria, fungi, and mycobacteria were negative, and treatment with oral erythromycin and topical metronidazole had been precribed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Skin ultrasound (18<span class="elsevierStyleHsp" style=""></span>MHz transducer) of the nodule in the left cheek revealed a well-defined, hypoechoic dermal lesion measuring 1.37<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>0.24<span class="elsevierStyleHsp" style=""></span>cm, with no posterior enhancement. No Doppler signal was observed and the lesion did not contain calcium deposits (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A diagnosis of IFAG was made based on the medical history, physical examination, and ultrasound findings. The lesions presented a progressive improvement (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and resolved spontaneously after 8 months.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">IFAG is more common in girls, and the mean age at presentation is 42.3 months.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> In 90% of cases the lesions are single and arise in the triangle between the labial commissure, the earlobe, and the medial canthus of the eye.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The etiology and pathogenesis of IFAG are unknown. It has been associated with insect bites and trauma, but no relationship with immunodeficiency or serious diseases has been demonstrated. No triggering infection has been detected, as microbiology cultures have been negative and there has been no response to antibiotic treatment. An embryogenic theory has been proposed, in which IFAG is the result of a granulomatous reaction to an embryologic remnant derived from cell migration.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Because of the site of IFAGs, their association with recurrent chalazion, and the good response, in some cases, to treatments used in rosacea, some authors have suggested the hypothesis that IFAGs form part of the spectrum of childhood rosacea.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,5</span></a> However, the spontaneous resolution of IFAGs without the need for treatment—something not observed in granulomatous rosacea—would argue against such a hypothesis. Prey et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> reported that children with IFAG have a higher risk of developing childhood rosacea, particularly the ocular form, and they proposed annual ophthalmologic evaluation to facilitate early diagnosis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Cultures are systematically negative, except in the event of superinfection, which should be suspected if sudden and rapid growth of the lesion is observed.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> Histologically, lesions are characterized by a chronic granulomatous reaction in the superficial and deep dermis, similar to that observed in foreign body or mycobacterial granulomas.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Skin ultrasound can be a useful tool to confirm a diagnosis of IFAG. The typical ultrasound pattern is one of a clearly defined, solid, hypoechoic dermal lesion with no calcium deposits.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> A hyperechoic lesion with a hypoechoic center has only been observed in 2 lesions, 1 of which showed posterior enhancement.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,7</span></a> Doppler study was negative except in 2 cases.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> In our patient, the absence of a Doppler signal may have been related to the fact that ultrasound examination was performed during an advanced phase of the lesion, as Doppler findings in IFAG may depend on the stage of the lesion when the study is performed.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The following conditions should be included in the sonographic differential diagnosis: epidermal cyst, a round anechoic lesion with posterior enhancement and a lateral acoustic shadow; pilomatrixoma, a round dermal lesion with variable central ecogenicity due to the presence of hyperechoic areas corresponding to calcifications, surrounded by a hypoechoic halo; pyogenic granuloma, a poorly defined, oval hypoechoic lesion, with a peripheral nutrient vessel and intense doppler flow internally; infantile hemangioma, a well-defined, homogeneous hypoechoic solid lesion with abundant blood vessels; and abscesses, well-defined hypoechoic or anechoic lesions with intense Doppler flow and anechoic linear fistulous tracts that communicate with the epidermis.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The clinical differential diagnosis is also broad: other benign tumors, such as dermoid cyst, juvenile xanthogranuloma, and Spitz nevus, bacterial, fungal, protozoal, or mycobacterial infections; insect bites; arteriovenous malformations; and paucisymptomatic nodulocystic childhood acne.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The lesions tend to resolve spontaneously after a mean period of 11 months and do not leave a scar.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In general, antibiotic therapy is ineffective, although some cases have shown a good response to oral macrolides or topical metronidazole.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">We must include IFAG in the differential diagnosis of acquired facial nodules in children. The medical history and the clinical, microbiologic, and ultrasound findings enable us to make an early diagnosis and to avoid unnecessary aggressive procedures.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => 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: Vázquez-Osorio I, Álvarez-Cuesta CC, Rodríguez-González L, Rodríguez-Díaz E. Granuloma aséptico facial idiopático. Utilidad de la ecografía cutánea. Actas Dermosifiliogr. 2017;108:266–268.</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" => 694 "Ancho" => 900 "Tamanyo" => 64362 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Asymptomatic erythematous-violaceous nodular lesions in the lower right eyelid and in the left cheek.</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" => 686 "Ancho" => 950 "Tamanyo" => 77456 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ultrasound study of the nodule in the left cheek showing a well-defined oval hypoechoic dermal lesion containing no calcium deposits.</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" => 708 "Ancho" => 1600 "Tamanyo" => 93763 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Spontaneous course of the lesions after 4 months. A, Right lower eyelid. B, Left cheek.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatoses bactériennes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Léaute-Labrèze" 1 => "J. Maleville" 2 => "A. Taïeb" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Dermatologie et maladies sexuellement transmissibles" "paginaInicial" => "114" "paginaFinal" => "121" "edicion" => "3rd ed." "serieFecha" => "1999" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic aseptic facial granuloma (pyodermite froide du visage): A pediatric entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Roul" 1 => "C. Léaute-Labrèze" 2 => "F. Boralevi" 3 => "P. Bioulac-Sage" 4 => "J. Maleville" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol." "fecha" => "2001" "volumen" => "137" "paginaInicial" => "1253" "paginaFinal" => "1255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11559236" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic facial aseptic granuloma: A multicentre prospective study of 30 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Boralevi" 1 => "C. Léaute-Labrèze" 2 => "S. Lepreux" 3 => "S. Barbarot" 4 => "Mazereeuw-Hautier" 5 => "C. Eschard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2006.07741.x" "Revista" => array:7 [ "tituloSerie" => "Br J Dermatol." "fecha" => "2007" "volumen" => "156" "paginaInicial" => "705" "paginaFinal" => "708" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17493068" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002937809010230" "estado" => "S300" "issn" => "00029378" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Epub ahead of print" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic facial aseptic granuloma: Case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Satta" 1 => "M.A. Montesu" 2 => "G. Biondi" 3 => "A. Lissia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Int J Dermatol." "fecha" => "2016" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic facial aseptic granuloma: Review of an evolving clinical entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.B. Zitelli" 1 => "A.T. Sheil" 2 => "R. Fleck" 3 => "A. Schwentker" 4 => "A.W. Lucky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pde.12571" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol." "fecha" => "2015" "volumen" => "32" "paginaInicial" => "e136" "paginaFinal" => "e139" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25847574" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "IFAG and childhood rosacea: A possible link" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Prey" 1 => "K. Ezzedine" 2 => "J. Mazereeuw-Hautier" 3 => "C. Eschard" 4 => "S. Barbarot" 5 => "F. Boralevi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pde.12137" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol." "fecha" => "2013" "volumen" => "30" "paginaInicial" => "429" "paginaFinal" => "432" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23560522" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Should idiopathic facial aseptic granuloma be considered granulomatous rosacea. Report of three pediatric cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Neri" 1 => "B. Raone" 2 => "A. Dondi" 3 => "C. Misciali" 4 => "A. Patrizi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-1470.2011.01689.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol." "fecha" => "2013" "volumen" => "30" "paginaInicial" => "109" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22340024" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic facial aseptic granuloma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.J. González-Rodríguez" 1 => "E. Jordá-Cuevas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ced.12535" "Revista" => array:7 [ "tituloSerie" => "Clin Exp Dermatol." "fecha" => "2015" "volumen" => "40" "paginaInicial" => "298" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25557471" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673610602796" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ecografía en dermatología pediátrica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.J. García-Martínez" 1 => "F.Z. Muñoz-Garza" 2 => "A. Hernández-Martín" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0001-7310(16)30010-2" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2015" "volumen" => "106" "paginaInicial" => "76" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26895942" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic facial aseptic granuloma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Hiraldo-Gamero" 1 => "A. Vera-Casaño" 2 => "A. Sanz-Trélles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.adengl.2012.12.007" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2013" "volumen" => "104" "paginaInicial" => "635" "paginaFinal" => "636" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23891450" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000003/v1_201703250116/S1578219017300306/v1_201703250116/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/15782190/0000010800000003/v1_201703250116/S1578219017300306/v1_201703250116/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017300306?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 15 | 7 | 22 |
| 2024 Octubre | 137 | 51 | 188 |
| 2024 Septiembre | 113 | 26 | 139 |
| 2024 Agosto | 142 | 107 | 249 |
| 2024 Julio | 167 | 35 | 202 |
| 2024 Junio | 156 | 24 | 180 |
| 2024 Mayo | 131 | 30 | 161 |
| 2024 Abril | 123 | 32 | 155 |
| 2024 Marzo | 116 | 32 | 148 |
| 2024 Febrero | 127 | 34 | 161 |
| 2024 Enero | 110 | 32 | 142 |
| 2023 Diciembre | 114 | 15 | 129 |
| 2023 Noviembre | 129 | 30 | 159 |
| 2023 Octubre | 107 | 19 | 126 |
| 2023 Septiembre | 119 | 36 | 155 |
| 2023 Agosto | 78 | 16 | 94 |
| 2023 Julio | 143 | 35 | 178 |
| 2023 Junio | 103 | 23 | 126 |
| 2023 Mayo | 126 | 22 | 148 |
| 2023 Abril | 96 | 19 | 115 |
| 2023 Marzo | 121 | 37 | 158 |
| 2023 Febrero | 133 | 25 | 158 |
| 2023 Enero | 119 | 33 | 152 |
| 2022 Diciembre | 103 | 53 | 156 |
| 2022 Noviembre | 97 | 36 | 133 |
| 2022 Octubre | 76 | 28 | 104 |
| 2022 Septiembre | 74 | 62 | 136 |
| 2022 Agosto | 47 | 33 | 80 |
| 2022 Julio | 45 | 39 | 84 |
| 2022 Junio | 40 | 30 | 70 |
| 2022 Mayo | 122 | 51 | 173 |
| 2022 Abril | 146 | 47 | 193 |
| 2022 Marzo | 140 | 53 | 193 |
| 2022 Febrero | 123 | 43 | 166 |
| 2022 Enero | 154 | 52 | 206 |
| 2021 Diciembre | 92 | 38 | 130 |
| 2021 Noviembre | 100 | 57 | 157 |
| 2021 Octubre | 154 | 64 | 218 |
| 2021 Septiembre | 207 | 48 | 255 |
| 2021 Agosto | 105 | 41 | 146 |
| 2021 Julio | 83 | 26 | 109 |
| 2021 Junio | 106 | 40 | 146 |
| 2021 Mayo | 108 | 55 | 163 |
| 2021 Abril | 315 | 88 | 403 |
| 2021 Marzo | 177 | 44 | 221 |
| 2021 Febrero | 118 | 27 | 145 |
| 2021 Enero | 90 | 33 | 123 |
| 2020 Diciembre | 73 | 28 | 101 |
| 2020 Noviembre | 71 | 26 | 97 |
| 2020 Octubre | 60 | 27 | 87 |
| 2020 Septiembre | 85 | 29 | 114 |
| 2020 Agosto | 49 | 32 | 81 |
| 2020 Julio | 42 | 19 | 61 |
| 2020 Junio | 47 | 43 | 90 |
| 2020 Mayo | 30 | 19 | 49 |
| 2020 Abril | 34 | 16 | 50 |
| 2020 Marzo | 31 | 13 | 44 |
| 2020 Febrero | 5 | 0 | 5 |
| 2019 Mayo | 1 | 1 | 2 |
| 2019 Abril | 0 | 4 | 4 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Julio | 1 | 0 | 1 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 75 | 7 | 82 |
| 2018 Enero | 76 | 9 | 85 |
| 2017 Diciembre | 88 | 7 | 95 |
| 2017 Noviembre | 77 | 8 | 85 |
| 2017 Octubre | 78 | 11 | 89 |
| 2017 Septiembre | 77 | 11 | 88 |
| 2017 Agosto | 43 | 10 | 53 |
| 2017 Julio | 56 | 8 | 64 |
| 2017 Junio | 79 | 10 | 89 |
| 2017 Mayo | 55 | 12 | 67 |
| 2017 Abril | 220 | 29 | 249 |
| 2017 Marzo | 24 | 20 | 44 |
| 2017 Febrero | 0 | 1 | 1 |
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