e-Case Report
Electrosurgery for the Treatment of Moderate or Severe Rhinophyma
Tratamiento con electrocirugía del rinofima moderado-grave
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González, H. Herrera, A. Motta" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L.F." "apellidos" => "González" "email" => array:1 [ 0 => "luisfer1000@gmail.com" ] "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" => "H." "apellidos" => "Herrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Motta" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Universidad El Bosque, Bogotá, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Simón Bolívar, Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento con electrocirugía del rinofima moderado-grave" ] ] "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" => 1564 "Ancho" => 1729 "Tamanyo" => 321008 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A, Patient 6, a 60-year-old man with severe rhinophyma. B, Good clinical response 2 weeks after electrosurgical treatment. Note the mild postsurgical erythema. C, Patient 7, a 56-year-old man with severe rhinophyma previously treated with isotretinoin. D, Surgical response with good scarring 12 weeks after the procedure.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rosacea is a chronic inflammatory skin disease that affects blood vessels and pilosebaceous units.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> Of the various clinical presentations of rosacea, the least common is rhinophyma, accounting for 3.7% of rosacea cases and occurring almost exclusively in men between the fifth and seventh decades of life.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1,2</span></a> The highest prevalence of rhinophyma is found in western Scotland.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> Rhinophyma is characterized by sebaceous hyperplasia, fibrous tissue proliferation, vascular bed alteration, and induration of the skin.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> Although the term <span class="elsevierStyleItalic">rhinophyma</span> refers to involvement of the nasal tip, the condition can spread to other parts of the face, including the chin (gnathophyma), ears (otophyma), forehead (metophyma), and eyelids (blepharophyma).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> Several surgical treatments are available, including dermabrasion, cryosurgery, scalpel excision, electrosurgery, and carbon dioxide laser.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4,5</span></a> The last 2 techniques are most effective for the management of rhinophyma.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">6–9</span></a> In this article, we describe a series of cases of moderate or severe rhinophyma treated with high-frequency electrosurgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Patients and Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">All patients with moderate or severe rhinophyma treated with high-frequency electrosurgery in the dermatology department of Hospital Simón Bolívar or in the authors’ private clinics in Bogota, Colombia, between 2012 and 2016 were enrolled in the study. Rhinophyma severity was assessed using the criteria proposed by El-Azhary et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a>: mild (telangiectasias and hyperplasia of the dermis), moderate (nasal hypertrophy and formation of lobular areas), or severe (nasal hypertrophy and prominent lobules).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> All patients underwent high-frequency (30-40<span class="elsevierStyleHsp" style=""></span>W) electrosurgery in cutting-coagulation mode at 2.5-3<span class="elsevierStyleHsp" style=""></span>MHz (Ellman Surgitron FFPF EMC, Ellman International, Inc., United States). Before the procedure, all patients received local anesthesia with 1% lidocaine with 1:200<span class="elsevierStyleHsp" style=""></span>000 epinephrine and underwent electrocoagulation treatment of any varicose veins or prominent telangiectasias. Layer-by-layer decortication was performed with a triangle-tip electrosurgical knife to the depth of the reticular dermis. The aesthetic units of the nose were respected and the deepest third of the sebaceous glands was preserved. Dermabrasion with water sandpaper (220- and 360-grit) was carried out until uniform punctate bleeding was achieved. Hemostasis was achieved with electrocoagulation and 40% ferric chloride solution was applied until hematic crusts formed. Patients attended a follow-up visit 15 days after the procedure. Six of the 7 patients used silicone gel sheeting (Dermasof, Laboratorio Incit, Colombia) and all patients received anti-inflammatory drugs for pain management for 24 to 48<span class="elsevierStyleHsp" style=""></span>hours after the procedure. Follow-up visits were scheduled at 2, 4, and 12 weeks after the procedure.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0015" class="elsevierStylePara elsevierViewall">Seven men between 40 and 69 years of age were treated with electrosurgery (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). All patients had a skin phototype between <span class="elsevierStyleSmallCaps">ii</span> and <span class="elsevierStyleSmallCaps">iv</span> and had been diagnosed with moderate or severe rhinophyma. Six of the patients (85%) had received prior treatment for rosacea; of these, 4 (57%) were treated for phymatous rosacea with isotretinoin and 2 (28%) were treated with carbon dioxide laser with no clinical response. One patient had received no prior treatment (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The cosmetic result, as assessed by both the clinicians and the patients, was satisfactory in all cases. The postsurgical follow-up period ranged from 12 weeks to 2 years (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Three patients presented scars, which were treated with infiltrations and silicone gel sheeting, and 2 patients presented persistent erythema (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). None of the patients required further surgery or had severe complications such as infection or keloids. No posttreatment pigmentation changes were observed in patients with skin phototype <span class="elsevierStyleSmallCaps">iii</span> or <span class="elsevierStyleSmallCaps">iv</span> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dilated pores were observed in 3 patients (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1</a><span class="elsevierStyleHsp" style=""></span>A and 1<span class="elsevierStyleHsp" style=""></span>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Given the low incidence of rhinophyma and the lack of randomized studies assessing the various techniques available, the ideal management of this condition has not been standardized.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> Due to its speed, efficiency, and low cost, high-frequency electrosurgery allows satisfactory management of rhinophyma.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> Favorable cosmetic results can be achieved by remodeling and removing nasal tissue with a triangle-tip electrosurgical knife. Heat-induced damage of the surrounding tissue is minimal, as is the risk of necrosis of cartilage and scarring.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> In this case series, 3 patients presented visible scarring; nevertheless, the patients’ perception of the cosmetic result was very satisfactory. The key to successful surgery is to achieve sufficient depth of decortication while respecting the aesthetic units of the nose—in particular the alae nasi and the tip—because the there is risk of scarring due to the proximity of the cartilage to the dermis. The objective of the surgery is to preserve the deepest part of the pilosebaceous unit, thereby guaranteeing adequate epithelization, which gives the nasal skin a normal porous appearance and prevents atrophic scarring.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">7–9</span></a> Carbon dioxide laser vaporization has been widely used in mild to severe rhinophymas, with satisfactory cosmetic results.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">6,11</span></a> However, carbon dioxide laser treatment requires training on the part of the clinician applying the technique and greater expertise in the appropriate parameters for the specific equipment used; moreover, it is an expensive surgical alternative.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> In other case series, simple techniques such as decortication by scalpel and electrosurgery yielded no differences in postinflammatory pigmentary alterations in comparison to carbon dioxide laser treatment.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> Surgical techniques involving decortication of hypertrophic tissue that preserve the deepest part of the sebaceous glands in order to guarantee adequate reepithelization—such as scalpel excision and electrosurgery—are easy to use and achieve good cosmetic results.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> This study—one of the few case series involving a nonwhite Latino population—achieved excellent cosmetic results and good patient satisfaction.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Electrosurgery is one of the most cost-effective techniques currently available,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> easy for dermatologists to perform, and more effective in the treatment of moderate to severe rhinophyma. Innovative techniques such as carbon dioxide laser treatment should be reserved for mild to moderate cases of rhinophyma and performed by trained specialists with experience in the use of these devices. Moreover, patients should be consulted in assessing the cost of these techniques.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of persons and animals</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed complied with the ethical standards of the corresponding human experimentation committee and the World Medical Association and with the principles of the Declaration of Helsinki.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Data confidentiality</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they followed their hospital's regulations regarding the publication of patient information.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data appear in this article.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">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:11 [ 0 => array:3 [ "identificador" => "xres1022283" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec980444" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1022282" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec980443" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of persons and animals" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of Interest" ] 10 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec980444" "palabras" => array:3 [ 0 => "Rhinophyma" 1 => "Sebaceous hyperplasia" 2 => "Electrosurgery" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec980443" "palabras" => array:3 [ 0 => "Rinofima" 1 => "Hiperplasia sebácea" 2 => "Electrocirugía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rhinophyma, a rare and progressive disfiguring condition, is thought to be the final stage of rosacea. Several surgical treatments are available, including dermabrasion, cryosurgery, scalpel excision, electrosurgery, and carbon dioxide laser. The last 2 techniques are the most effective for the management of rhinophyma. We describe a series of cases of moderate or severe rhinophyma treated with high-frequency electrosurgery in the dermatology department of Hospital Simón Bolivar and in private clinics in Bogota, Colombia, between 2012 and 2016. The cosmetic result, as assessed by both the clinicians and the patients, was satisfactory in all cases. Three patients presented hypertrophic scars that were treated with steroid injections and silicone gel sheeting. Two patients presented persistent erythema. However, there were no serious infections and none of the patients required further surgery. Electrosurgery is one of the simplest and most cost-effective techniques currently available for the treatment of rhinophyma by dermatologists.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El rinofima se considera el estado final de la rosácea, siendo una condición desfigurante progresiva y poco común. Existen diferentes alternativas quirúrgicas como la dermoabrasión, la criocirugía, la escisión con escalpelo, la electrocirugía y el láser CO<span class="elsevierStyleInf">2</span>. Estas 2 últimas técnicas son las más efectivas en el manejo del rinofima. Se describe una serie de casos de pacientes con rinofima moderado-grave que recibieron manejo con electrocirugía de alta frecuencia en el Servicio de Dermatología del Hospital Simón Bolívar y práctica privada entre 2012 y 2016. Todos los pacientes mostraron respuesta estética satisfactoria basada en el criterio médico y la percepción del paciente. Tres pacientes presentaron cicatrices hipertróficas manejadas con infiltraciones y bandas de silicona. Dos pacientes presentaron eritema persistente. Ningún caso requirió un segundo tiempo quirúrgico, ni infección grave. La electrocirugía es una de las técnicas vigentes más coste-efectivas y de fácil realización por el dermatólogo para el tratamiento del rinofima.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: González LF, Herrera H, Motta A. Tratamiento con electrocirugía del rinofima moderado-grave Actas Dermosifiliogr. 2018;109:e23–e26.</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" => 1012 "Ancho" => 1733 "Tamanyo" => 271492 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Patient 1, a 56-year-old man with severe rhinophyma. B, Excellent results 2 years after the procedure. Note the persistence of dilated pores and the absence of pigmentary alterations in this patient with skin phototype <span class="elsevierStyleSmallCaps">iv</span>. C, Patient 5, a 50-year-old man previously treated with isotretinoin and carbon dioxide laser. D, Significant improvement in hyperplasia on the right ala nasi and nasal tip 20 weeks after electrosurgical treatment.</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" => 1564 "Ancho" => 1729 "Tamanyo" => 321008 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A, Patient 6, a 60-year-old man with severe rhinophyma. B, Good clinical response 2 weeks after electrosurgical treatment. Note the mild postsurgical erythema. C, Patient 7, a 56-year-old man with severe rhinophyma previously treated with isotretinoin. D, Surgical response with good scarring 12 weeks after the procedure.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "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 \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, y \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">Severity of Rhinophyma<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \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">Previous Treatment \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">Scarring \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">Erythema \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">Cosmetic Result \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">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Isotretinoin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Excellent \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">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Isotretinoin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \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">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Isotretinoin<br>Topical metronidazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Excellent \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">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Excellent \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">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Isotretinoin<br>Carbon dioxide laser \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \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">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \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">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Isotretinoin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737274.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">According to the severity scale proposed by El-Azhary et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> (mild, telangiectasias and hyperplasia of the dermis; moderate, nasal hypertrophy and formation of lobular areas; or severe, nasal hypertrophy and prominent lobules).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Characteristics and Clinical Responses of Patients Treated With Electrosurgery.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rosácea. Impacto psicosocial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.C. García-Bustínduy" 1 => "V. García-Fumero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2016" "volumen" => "31" "paginaInicial" => "96" "paginaFinal" => "105" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0070" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rinofima severo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Troncoso" 1 => "R. Torrealba" 2 => "F. Bozán" 3 => "A. Lazo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Chil Cir" "fecha" => "2012" "volumen" => "64" "paginaInicial" => "194" "paginaFinal" => "198" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0075" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rosacea: actualización" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.I. Barona" 1 => "B. Orozco" 2 => "A. Motta" 3 => "E. Meléndez" 4 => "R. Flaminio" 5 => "J.G. Pabón" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2015" "volumen" => "30" "paginaInicial" => "485" "paginaFinal" => "502" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0080" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rhinophyma: Review and update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Rohrich" 1 => "J. Griffin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "2002" "volumen" => "110" "paginaInicial" => "860" "paginaFinal" => "870" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12172152" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0085" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Excision of rhinophyma with high-frequency electrosurgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Aferzon" 1 => "B. Millman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2002" "volumen" => "28" "paginaInicial" => "735" "paginaFinal" => "738" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12174068" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0090" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carbon dioxide laser treatment of rhinophyma: A review of 124 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Madan" 1 => "J.E. Ferguson" 2 => "P.J. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 9 | 22 |
| 2024 Octubre | 129 | 55 | 184 |
| 2024 Septiembre | 136 | 31 | 167 |
| 2024 Agosto | 147 | 95 | 242 |
| 2024 Julio | 119 | 55 | 174 |
| 2024 Junio | 134 | 67 | 201 |
| 2024 Mayo | 107 | 51 | 158 |
| 2024 Abril | 134 | 44 | 178 |
| 2024 Marzo | 125 | 27 | 152 |
| 2024 Febrero | 111 | 42 | 153 |
| 2024 Enero | 111 | 32 | 143 |
| 2023 Diciembre | 182 | 21 | 203 |
| 2023 Noviembre | 269 | 33 | 302 |
| 2023 Octubre | 221 | 44 | 265 |
| 2023 Septiembre | 228 | 36 | 264 |
| 2023 Agosto | 131 | 23 | 154 |
| 2023 Julio | 180 | 42 | 222 |
| 2023 Junio | 123 | 29 | 152 |
| 2023 Mayo | 139 | 36 | 175 |
| 2023 Abril | 210 | 32 | 242 |
| 2023 Marzo | 126 | 41 | 167 |
| 2023 Febrero | 106 | 32 | 138 |
| 2023 Enero | 103 | 38 | 141 |
| 2022 Diciembre | 79 | 61 | 140 |
| 2022 Noviembre | 91 | 34 | 125 |
| 2022 Octubre | 56 | 31 | 87 |
| 2022 Septiembre | 60 | 40 | 100 |
| 2022 Agosto | 39 | 37 | 76 |
| 2022 Julio | 41 | 36 | 77 |
| 2022 Junio | 60 | 41 | 101 |
| 2022 Mayo | 132 | 54 | 186 |
| 2022 Abril | 176 | 67 | 243 |
| 2022 Marzo | 194 | 75 | 269 |
| 2022 Febrero | 205 | 41 | 246 |
| 2022 Enero | 253 | 79 | 332 |
| 2021 Diciembre | 191 | 69 | 260 |
| 2021 Noviembre | 163 | 65 | 228 |
| 2021 Octubre | 212 | 76 | 288 |
| 2021 Septiembre | 155 | 55 | 210 |
| 2021 Agosto | 167 | 54 | 221 |
| 2021 Julio | 141 | 52 | 193 |
| 2021 Junio | 271 | 44 | 315 |
| 2021 Mayo | 258 | 51 | 309 |
| 2021 Abril | 675 | 138 | 813 |
| 2021 Marzo | 356 | 54 | 410 |
| 2021 Febrero | 276 | 56 | 332 |
| 2021 Enero | 173 | 53 | 226 |
| 2020 Diciembre | 181 | 39 | 220 |
| 2020 Noviembre | 140 | 42 | 182 |
| 2020 Octubre | 75 | 22 | 97 |
| 2020 Septiembre | 88 | 29 | 117 |
| 2020 Agosto | 71 | 40 | 111 |
| 2020 Julio | 61 | 26 | 87 |
| 2020 Junio | 64 | 39 | 103 |
| 2020 Mayo | 28 | 22 | 50 |
| 2020 Abril | 28 | 19 | 47 |
| 2020 Marzo | 40 | 20 | 60 |
| 2020 Febrero | 4 | 0 | 4 |
| 2019 Diciembre | 8 | 0 | 8 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 12 | 0 | 12 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 6 | 0 | 6 |
| 2019 Abril | 2 | 0 | 2 |
| 2019 Marzo | 2 | 0 | 2 |
| 2019 Febrero | 4 | 0 | 4 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Septiembre | 3 | 0 | 3 |
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