Case and Research Letter
Exogenous Ochronosis in Facial Melasma
Ocronosis exógena en melasma facial
Leído
12581
Vecesse ha leído el artículo
2396
Total PDF
10185
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219017300562" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.03.006" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1542" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:381-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 849 "formatos" => array:3 [ "EPUB" => 47 "HTML" => 656 "PDF" => 146 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731016303581" "issn" => "00017310" "doi" => "10.1016/j.ad.2016.10.006" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1542" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:381-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 843 "formatos" => array:3 [ "EPUB" => 5 "HTML" => 764 "PDF" => 74 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cartas científico-clínica</span>" "titulo" => "Ocronosis exógena en melasma facial" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "381" "paginaFinal" => "383" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Exogenous Ochronosis in Facial Melasma" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 477 "Ancho" => 1843 "Tamanyo" => 242423 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">a y b) Depósito de material acelular de color dorado pálido y forma alargada en dermis superficial, en forma de «plátanos o bananos», imagen típica de OE (H&E ×10 y ×40), c) Reforzamiento del pigmento melánico (Fontana-Masson ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.E. Córdova, D.O. Pérez-Rojas, A.D. López-Marquet, R. Arenas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.E." "apellidos" => "Córdova" ] 1 => array:2 [ "nombre" => "D.O." "apellidos" => "Pérez-Rojas" ] 2 => array:2 [ "nombre" => "A.D." "apellidos" => "López-Marquet" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Arenas" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219017300562" "doi" => "10.1016/j.adengl.2017.03.006" "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/S1578219017300562?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016303581?idApp=UINPBA000044" "url" => "/00017310/0000010800000004/v2_201705020105/S0001731016303581/v2_201705020105/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219017300604" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.03.010" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1541" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:383-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 677 "formatos" => array:3 [ "EPUB" => 59 "HTML" => 461 "PDF" => 157 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Efficacy and Safety of Omalizumab in a Patient With Chronic Spontaneous Urticaria and Active Hepatitis B Virus Infection" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "383" "paginaFinal" => "384" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficacia y seguridad de omalizumab en un paciente con urticaria crónica espontánea e infección activa por el virus de la hepatitis B" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 841 "Ancho" => 1664 "Tamanyo" => 64111 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Changes in Urticaria Activity Score 7 (UAS7) scores and hepatitis B viral loads measured by polymerase chain reaction (PCR HBV) during treatment with omazlizumab.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Chicharro, P. Rodríguez-Jiménez, D. de Argila" "autores" => array:3 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Chicharro" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Rodríguez-Jiménez" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "de Argila" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101630357X" "doi" => "10.1016/j.ad.2016.10.005" "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/S000173101630357X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017300604?idApp=UINPBA000044" "url" => "/15782190/0000010800000004/v1_201704280927/S1578219017300604/v1_201704280927/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219017300616" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.03.011" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "1543" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:378-80" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 846 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 623 "PDF" => 175 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Genital Vitiligo-like Hypopigmentation After Treatment With 5% Imiquimod" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "378" "paginaFinal" => "380" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipopigmentación genital similar a vitíligo tras tratamiento con imiquimod 5%" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1139 "Ancho" => 2333 "Tamanyo" => 340674 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Achromic macules on the shaft of the penis and foreskin. B, More evident loss of pigmentation under Wood's light.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. García-Montero, J.B. Repiso Jiménez, M.T. Fernández Morano, M. de Troya Martín" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "García-Montero" ] 1 => array:2 [ "nombre" => "J.B. Repiso" "apellidos" => "Jiménez" ] 2 => array:2 [ "nombre" => "M.T. Fernández" "apellidos" => "Morano" ] 3 => array:2 [ "nombre" => "M. de Troya" "apellidos" => "Martín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731016303593" "doi" => "10.1016/j.ad.2016.10.007" "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/S0001731016303593?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017300616?idApp=UINPBA000044" "url" => "/15782190/0000010800000004/v1_201704280927/S1578219017300616/v1_201704280927/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Exogenous Ochronosis in Facial Melasma" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "381" "paginaFinal" => "383" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.E. Córdova, D.O. Pérez-Rojas, A.D. López-Marquet, R. Arenas" "autores" => array:4 [ 0 => array:3 [ "nombre" => "M.E." "apellidos" => "Córdova" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "D.O." "apellidos" => "Pérez-Rojas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A.D." "apellidos" => "López-Marquet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:4 [ "nombre" => "R." "apellidos" => "Arenas" "email" => array:1 [ 0 => "rarenas98@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Dermatología, Hospital Ángeles León, Guanajuato, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección de Micología, Hospital General «Dr. Manuel Gea González», Ciudad de México, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ocronosis exógena en melasma facial" ] ] "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" => 1353 "Ancho" => 827 "Tamanyo" => 150416 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diffuse dark-brown macules on the forehead and dorsum of the nose and small dark-gray hyperpigmented macules in the malar region and on the cheeks.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ochronosis is a disease in which ochre pigment is deposited in the tissues. Two forms have been described: endogenous and exogenous. The 2 forms have different clinical presentations and laboratory alterations, but the histology features are identical.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The endogenous form, also known as alcaptonuria, is of autosomal recessive inheritance and is due to a congenital deficiency of the enzyme homogentisic acid oxidase (HGAO), which is involved in the metabolism of the amino acids phenylalanine and tyrosine. The deficit of HGAO leads to tissue accumulation of homogentisic acid (HGA), which is excreted in high concentrations in the urine and in secretions.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In exogenous ochronosis (EO), deposits of polymerized HGA build up in the superficial dermis due to local inhibition of the enzyme HGAO caused by a prolonged use of topical treatments such as hydroquinone and its derivatives.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We describe the case of a 49-year-old housewife born and resident in Leon, Guanajuato, Mexico. In her background we detected a 2-year history of hypothyroidism. She consulted for a 16-year history of hyperchromic macules on both her cheeks and on her forehead. For the previous 15 years, the macules had been treated with hydroquinone for long but intermittent periods. She had also used home remedies and sunscreen without observing any improvement.</p><p id="par0025" class="elsevierStylePara elsevierViewall">On examination, a symmetrical, bilateral facial dermatosis was observed affecting both cheeks and the dorsum of the nose, but respecting the periocular region, the nasolabial fold, and the perioral area. The dermatosis consisted of diffuse dark brown macules on the forehead and cheeks, and hyperpigmented dark gray spots. The patient denied any symptoms (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2A</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Dermoscopy revealed an increase in the facial pseudonetwork, with intensely pigmented amorphous dark-brown structures with a reticular pattern; these structures obstructed the follicular openings (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Histopathology with hematoxylin and eosin stain showed long, banana-shaped deposits of an acellular material of a pale gold color, with a mild lymphohistiocytic interstitial inflammatory infiltrate (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>, A and B). Fontana-Masson stain highlighted the melanic pigment (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>C). These findings confirmed the clinical and dermoscopic diagnosis of EO.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">EO presents as a symmetrical bilateral dermatosis that typically affects sun-exposed areas and the skin over bony prominences, most commonly in the malar and temporal regions and area of the mandible and chin. It is characterized by hyperpigmented reticulated macules, of dark gray or grayish brown color, with lighter and darker areas, giving a clinical appearance similar to caviar.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The worldwide prevalence is considered to be low. It is most common in women in the third and fourth decades of life, and particularly affects phototypes III and <span class="elsevierStyleSmallCaps">iv.</span><a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The onset of EO has been associated with hydroquinone and also with numerous other substances: topical mercurials, oral and parenteral antimalarial drugs, the application of phenol, resorcinol, or picric acid, and levodopa. However, no single etiologic factor that triggers the disease has been identified. Our patient had been diagnosed 16 years earlier with melasma affecting her frontal and malar regions. However, despite the clear clinical evidence of EO, the patient continued to be prescribed hydroquinone for the treatment of her hyperpigmentation, using it for a total of 15 years.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,6,7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Dermoscopy is a non-invasive method that can aid diagnosis of EO very specifically. The dermoscopic features are the presence of amorphous annular and arcuate structures that are dark blue or grayish-black in color depending on the depth of the pigment in the skin. These structures surround and occasionally obliterate follicles orifices, and there is an accentuation of the normal pseudonetwork of the skin of the face. Our patient presented the characteristic changes, with amorphous and reticulated hyperpigmented structures (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7–9</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The differential diagnosis includes melasma, bilateral Ota nevus, drug-induced hyperpigmentation, postinflammatory pigmentation, and dermatosis papulosa nigra<span class="elsevierStyleItalic">.</span><a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The definitive diagnosis is made by the detection of deposits of HGA in the superficial dermis in the form of long, banana-like, curvilinear structures of different sizes and of yellow-gold color. Other changes have been reported, including edema and degeneration of collagen fibers and a histiocytic and plasma cell inflammatory infiltrate. Solar elastosis and pigment incontinence are often observed.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">It is important for the dermatologist to recognize the clinical presentation and the dermoscopy and histopathology findings of this dyschromia induced by hydroquinone, one of the most common depigmenting agents used in medical practice to treat melasma, and which is available over the counter in many countries. Furthermore, exogenous ochronosis can be confused with other pigment disorders, including melasma itself, and this must be taken into account in the differential diagnosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Córdova ME, Pérez-Rojas DO, López-Marquet AD, Arenas R. Ocronosis exógena en melasma facial. Actas Dermosifiliogr. 2017;108:381–383.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1353 "Ancho" => 827 "Tamanyo" => 150416 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diffuse dark-brown macules on the forehead and dorsum of the nose and small dark-gray hyperpigmented macules in the malar region and on the cheeks.</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" => 540 "Ancho" => 1417 "Tamanyo" => 157080 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Detail of the lesions on the cheeks. B, Dermoscopy image: increased facial pseudonetwork and intensely pigmented, amorphous dark-brown structures that obstruct follicular orifices.</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" => 477 "Ancho" => 1843 "Tamanyo" => 242423 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histology. Elongated banana-shaped deposits of a pale-gold–colored acellular material in the superficial dermis, a typical image of exogenous ochronosis. Hematoxylin and eosin, original magnification A, ×10 and B, ×40. C, Highlighting of the melanic pigment. Fontana-Masson stain, original magnification ×40.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1687 "Ancho" => 2307 "Tamanyo" => 229290 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Diagnostic algorithm for facial melanosis.</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" => "Ocronosis endógena: descripción de un caso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.L. Díaz-Ramón" 1 => "B. Aseguinolaza" 2 => "M.R.> González-Hermosa" 3 => "R. González-Pérez" 4 => "B. Catón" 5 => "R. Soloeta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2005" "volumen" => "96" "paginaInicial" => "525" "paginaFinal" => "528" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16476288" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications of chronic use of skin lightening cosmetics" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.M. Olumide" 1 => "A.O. Akinkugbe" 2 => "D. Altraide" 3 => "T. Mohammed" 4 => "N. Ahamefule" 5 => "S. Ayanlowo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2008.02719.x" "Revista" => array:6 [ "tituloSerie" => "Int J Derm" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "344" "paginaFinal" => "353" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18377596" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La ocronosis exógena: ¿Qué tanto la diagnosticamos o la diferenciamos del melasma?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Vargas-Martínez" 1 => "P. Valdés" 2 => "R. Arenas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatología CMQ" "fecha" => "2012" "volumen" => "10" "paginaInicial" => "143" "paginaFinal" => "147" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ocronosis exógena: Revisión del tema a propósito de un caso por uso prolongado de hidroquinona" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Úruaga" 1 => "J.C. Garces" 2 => "M.C. Briones" 3 => "M.V. Úruaga" 4 => "A. Lubkov" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatologia (Ecuador)" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "8" "paginaFinal" => "13" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatología Atlas. Diagnóstico y Tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Arenas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:6 [ "edicion" => "6.<span class="elsevierStyleSup"><span class="elsevierStyleItalic">a</span></span> ed." "fecha" => "2015" "paginaInicial" => "144" "paginaFinal" => "147" "editorial" => "McGraw-Hill" "editorialLocalizacion" => "México" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ocronosis exógena: informe de un caso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Chang" 1 => "R. Rodríguez-Pellecer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatología CMQ" "fecha" => "2014" "volumen" => "12" "paginaInicial" => "199" "paginaFinal" => "202" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopic and reflectance confocal microscopic features of exogenous ochronosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Gil" 1 => "S. Segura" 2 => "E. Martínez-Escala" 3 => "J. Lloreta" 4 => "S. Puig" 5 => "M. Vélez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2010.205" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2010" "volumen" => "146" "paginaInicial" => "1021" "paginaFinal" => "1025" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20855704" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hydroquinone-induced exogenous ochronosis: A report of four cases and usefulness of dermoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Charlín" 1 => "C.B. Barcaui" 2 => "B.K. Kac" 3 => "D.B. Soares" 4 => "R. Rabello-Fonseca" 5 => "L. Azulay-Abulafia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2007.03351.x" "Revista" => array:7 [ "tituloSerie" => "Int J Derm" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "19" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18173595" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0272638613012067" "estado" => "S300" "issn" => "02726386" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopic criteria for differentiating exogenous ochronosis from melasma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Khunger" 1 => "R. Kandhari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0378-6323.120741" "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol Venereol Leprol" "fecha" => "2013" "volumen" => "79" "paginaInicial" => "819" "paginaFinal" => "821" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24177620" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exogenous ochronosis hydroquinone induced: A report of four cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Ribas" 1 => "A. Schettini" 2 => "M. Cavalcante" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2010" "volumen" => "85" "paginaInicial" => "699" "paginaFinal" => "703" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21152798" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000004/v1_201704280927/S1578219017300562/v1_201704280927/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/15782190/0000010800000004/v1_201704280927/S1578219017300562/v1_201704280927/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017300562?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 28 | 12 | 40 |
| 2024 Octubre | 228 | 50 | 278 |
| 2024 Septiembre | 237 | 29 | 266 |
| 2024 Agosto | 257 | 91 | 348 |
| 2024 Julio | 255 | 32 | 287 |
| 2024 Junio | 203 | 32 | 235 |
| 2024 Mayo | 176 | 43 | 219 |
| 2024 Abril | 154 | 21 | 175 |
| 2024 Marzo | 161 | 37 | 198 |
| 2024 Febrero | 166 | 47 | 213 |
| 2024 Enero | 168 | 29 | 197 |
| 2023 Diciembre | 279 | 19 | 298 |
| 2023 Noviembre | 290 | 51 | 341 |
| 2023 Octubre | 242 | 49 | 291 |
| 2023 Septiembre | 245 | 44 | 289 |
| 2023 Agosto | 235 | 51 | 286 |
| 2023 Julio | 213 | 64 | 277 |
| 2023 Junio | 201 | 46 | 247 |
| 2023 Mayo | 335 | 32 | 367 |
| 2023 Abril | 241 | 25 | 266 |
| 2023 Marzo | 214 | 44 | 258 |
| 2023 Febrero | 210 | 29 | 239 |
| 2023 Enero | 158 | 57 | 215 |
| 2022 Diciembre | 162 | 46 | 208 |
| 2022 Noviembre | 153 | 37 | 190 |
| 2022 Octubre | 140 | 28 | 168 |
| 2022 Septiembre | 145 | 40 | 185 |
| 2022 Agosto | 120 | 33 | 153 |
| 2022 Julio | 124 | 39 | 163 |
| 2022 Junio | 173 | 49 | 222 |
| 2022 Mayo | 230 | 55 | 285 |
| 2022 Abril | 230 | 71 | 301 |
| 2022 Marzo | 207 | 76 | 283 |
| 2022 Febrero | 181 | 34 | 215 |
| 2022 Enero | 205 | 50 | 255 |
| 2021 Diciembre | 130 | 55 | 185 |
| 2021 Noviembre | 135 | 46 | 181 |
| 2021 Octubre | 146 | 63 | 209 |
| 2021 Septiembre | 156 | 38 | 194 |
| 2021 Agosto | 138 | 36 | 174 |
| 2021 Julio | 125 | 25 | 150 |
| 2021 Junio | 140 | 31 | 171 |
| 2021 Mayo | 139 | 58 | 197 |
| 2021 Abril | 385 | 56 | 441 |
| 2021 Marzo | 188 | 53 | 241 |
| 2021 Febrero | 126 | 34 | 160 |
| 2021 Enero | 106 | 26 | 132 |
| 2020 Diciembre | 98 | 19 | 117 |
| 2020 Noviembre | 75 | 29 | 104 |
| 2020 Octubre | 70 | 22 | 92 |
| 2020 Septiembre | 79 | 37 | 116 |
| 2020 Agosto | 56 | 24 | 80 |
| 2020 Julio | 79 | 14 | 93 |
| 2020 Junio | 81 | 34 | 115 |
| 2020 Mayo | 49 | 17 | 66 |
| 2020 Abril | 35 | 26 | 61 |
| 2020 Marzo | 24 | 14 | 38 |
| 2020 Febrero | 4 | 1 | 5 |
| 2019 Octubre | 1 | 0 | 1 |
| 2019 Septiembre | 2 | 0 | 2 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Mayo | 1 | 1 | 2 |
| 2019 Abril | 0 | 4 | 4 |
| 2019 Febrero | 1 | 0 | 1 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Febrero | 50 | 6 | 56 |
| 2018 Enero | 119 | 12 | 131 |
| 2017 Diciembre | 73 | 10 | 83 |
| 2017 Noviembre | 56 | 15 | 71 |
| 2017 Octubre | 43 | 7 | 50 |
| 2017 Septiembre | 59 | 8 | 67 |
| 2017 Agosto | 78 | 12 | 90 |
| 2017 Julio | 19 | 10 | 29 |
| 2017 Junio | 51 | 12 | 63 |
| 2017 Mayo | 74 | 28 | 102 |
| 2017 Abril | 11 | 18 | 29 |
| 2017 Marzo | 1 | 3 | 4 |
Mostrar todo
