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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2006&#44; Kossard and coworkers coined the term <span class="elsevierStyleItalic">urticarial dermatitis</span> &#40;UD&#41; to describe a histological skin reaction pattern with a broad clinical spectrum&#46; UD is primarily characterized by the presence of urticarial&#44; erythematous&#44; pruritic papules or plaques and eczematous lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Biopsy of urticarial areas reveals a normal stratum corneum&#44; minimal spongiosis&#44; and perivascular lymphocytic infiltrate of the papillary dermis with eosinophils &#40;with or without neutrophils&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In this descriptive observational study we describe the clinical and histological findings in 6 patients with a diagnosis suggestive of UD who were treated at the Eczema Unit of the Dermatology Service of a tertiary hospital in 2015 and 2016&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows corresponding data on epidemiology&#44; comorbidities&#44; clinical presentation&#44; initial clinical suspicion&#44; diagnostic tests&#44; final diagnosis&#44; disease duration at the time of diagnosis&#44; follow-up period&#44; treatment&#44; and progression&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The mean age at UD onset was 70 years &#40;range&#44; 45&#8211;88 years&#41;&#46; None of the patients had a personal or family history of atopy&#44; urticaria&#44; or any other skin disease&#46; All patients reported having pruritus and in all cases physical examination confirmed the presence of urticarial papules or plaques and clinical signs of dermatitis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Dermographism was detected in 4 patients &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; The initial clinical suspicions included UD&#44; chronic spontaneous urticaria &#40;CSU&#41;&#44; bullous pemphigoid&#44; and eczema&#46; Other clinical entities included in the differential diagnosis were drug reactions&#44; urticaria-vasculitis&#44; scabies&#44; and dermatitis herpetiformis&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In all cases&#44; a final diagnosis was established based on the results of diagnostic tests &#40;CSU in 3 patients&#44; drug reaction in 2 patients&#44; and Schnitzler syndrome in 1 patient&#41;&#46; The mean time from disease onset to final diagnosis was 7 months &#40;range&#44; 3&#8211;13 months&#41; and the mean duration of follow-up was 11&#46;3 months &#40;range&#44; 5&#8211;20 months&#41;&#46; All patients were initially treated with oral antihistamines and corticosteroids&#46; Improvement was observed in only 2 patients&#44; both of whom were later diagnosed with CSU&#46; All but 1 patient responded well to targeted treatment once the definitive diagnosis had been established&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">UD is not a discrete disorder&#44; but a group of skin diseases that share similar clinical and histological manifestations&#46; In many patients with clinically suspected UD a clinical-pathological correlation can be reached through accurate diagnostic assessment&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> although this can take several months&#46; Pathologists have used the term <span class="elsevierStyleItalic">dermal hypersensitivity reaction pattern</span> to describe UD&#44; despite the absence of a clinical or histological correlation between these presentations&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;3</span></a> All cases in this series initially posed a diagnostic challenge&#44; as none could be classified as a specific inflammatory disorder&#46; Ultimately&#44; a final diagnosis was established in all cases&#46; The most common diagnosis was CSU&#44; followed by drug reaction&#46; Our results differ from those previously reported in the literature&#58; Kossard and coworkers found that the most frequent clinical associations were eczema and drug reactions&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> while 47&#37; of the cases in the series by Hannon and coworkers were of idiopathic origin&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Certain histological clues may facilitate the establishment of a more specific diagnosis&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> particularly if observed in earlier disease stages when the lesions are more edematous and less excoriated&#46; The presence of spongiosis supports a diagnosis of eczema&#44; while its absence is suggestive of urticaria or lesions secondary to either drug reaction or urticaria&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Because UD can constitute the initial signs of bullous pemphigoid&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> it is advisable to perform direct immunofluorescence studies&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">UD typically affects elderly patients&#44; especially women&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;4</span></a> Because many patients are polymedicated&#44; it can be difficult to identify the causative agent in cases of suspected drug-induced UD&#46; UD lesions have a polymorphous appearance&#44; and exhibit features of urticaria and concomitant or simultaneous dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Eczematous lesions may be caused in part by the use of home remedies to relieve itching&#46; In our study&#44; physical examination revealed dermographism in some patients&#46; Although dermographism is typical of drug reaction&#44; scabies and&#44; above all&#44; CSU&#44; its presence can be particularly helpful in the diagnosis of UD&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">UD may involve a T helper 2 &#40;Th2&#41; lymphocyte reaction&#44; which precedes a dominant T helper 1 &#40;Th1&#41; cytokine profile&#44; particularly in cases of atopic dermatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;5</span></a> This induces the production of interleukin &#40;IL&#41;-4&#44; IL-5&#44; and IL-10&#44; all of which can give rise to eosinophilia and urticarial reactions&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The therapies most commonly used to treat UD include oral antihistamines&#44; topical and systemic corticosteroids&#44; narrowband ultraviolet B radiation&#44; and topical calcineurin inhibitors&#44; usually with unsatisfactory results&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> Some reports have described good responses to treatment with other therapeutic agents&#44; including cyclosporins&#44; mycophenolate mofetil&#44; azathioprine&#44; dapsone&#44; and hydroxyurea&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; UD is a common manifestation of several distinct skin diseases that appear to share a similar pathophysiological mechanism&#46; A final diagnosis can be established after exhaustive evaluation of the information obtained from anamnesis&#44; histology&#44; and other additional tests&#46; The detection of dermographism in the physical examination may help orient the diagnosis towards UD&#46; However&#44; this finding should not be considered a specific sign of any condition in particular&#46; In our opinion&#44; UD is a useful term to describe a skin reaction mainly observed in the elderly&#44; the clinical characteristics of which mimic those of several skin diseases&#46; In many cases&#44; a definitive diagnosis can only be established after long-term follow up&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a del Pozo MC&#44; Poveda I&#44; &#193;lvarez P&#44; Silvestre JF&#46; Dermatitis urticante&#46; Un patr&#243;n de reacci&#243;n cut&#225;nea&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;929&#8211;932&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Normal epidermis and dense perivascular lymphocytic infiltrate with abundant eosinophils&#46; Preserved dermoepidermal junction &#40;hematoxylin-eosin&#44; original magnification &#215;20&#41;&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Excoriated erythematous papules on the back of a patient&#46; B&#44; Use of the Fric test to confirm dermographism on the back of a patient with prurigo lesions at different stages of progression&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; BP&#44; bullous pemphigoid&#59; BPH&#44; benign prostatic hyperplasia&#59; BT&#44; blood test&#59; CBC&#44; complete blood count&#59; CSU&#44; chronic spontaneous urticaria&#59; DIF&#44; direct immunofluorescence&#59; DM&#44; diabetes mellitus&#59; DR&#44; drug reaction&#59; GF&#44; glomerular filtrate&#59; MTX&#44; methotrexate&#59; N&#47;A&#44; not applicable&#59; NSAIDs&#44; non-steroidal anti-inflammatory drugs&#59; OA&#44; oral antihistamines&#59; OC&#44; oral corticosteroids&#59; TC&#44; topical corticosteroids&#59; UD&#44; urticarial dermatitis&#59; WM&#44; Waldenstr&#246;m macroglobulinemia&#46;</p>"
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                  <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">Sex&nbsp;\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">Female&nbsp;\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">Male&nbsp;\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">Female&nbsp;\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">Male&nbsp;\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">Female&nbsp;\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">Female&nbsp;\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">Age&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&nbsp;\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">Comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DM<br>Dyslipidemia<br>Essential hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BPH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dyslipidemia<br>DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DM<br>BPH<br>Ischemic heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DM<br>Osteoporosis<br>WM<br>Ovarian teratoma&nbsp;\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">Dermographism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\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">Initial clinical suspicion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Scabies<br>Eczema<br>BP<br>UD<br>CSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BP<br>Eczema<br>UD<br>CSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UD<br>CSU<br>Urticaria-vasculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Allergic contact dermatitis<br>UD<br>BP<br>DR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Scabies<br>Eczema<br>CSU<br>Dermatitis herpetiformis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CSU<br>Urticaria-vasculitis DR<br>BP&nbsp;\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">Histology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal epidermis<br>Superficial dermal perivascular&#44; lymphocytic&#44; and eosinophilic infiltrate with presence of eosinophils<br>DIF&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Focal parakeratosis&#44; mild eosinophilic spongiosis&#44; and poor vacuolization of the basement membrane Superficial perivascular lymphocytic infiltrate<br>Interstitial lymphocytic and eosinophilic infiltrate<br>DIF&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal epidermis<br>Superficial dermal perivascular&#44; lymphocytic&#44; and eosinophilic infiltrate with interstitial eosinophils<br><br>DIF&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal epidermis<br>Superficial dermal perivascular&#44; lymphocytic&#44; and eosinophilic infiltrate<br>DIF&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal epidermis<br>Superficial dermal perivascular&#44; lymphocytic&#44; and eosinophilic infiltrate with interstitial eosinophils<br>DIF&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal epidermis<br>Mild dermal edema&#44; superficial and interstitial dermal perivascular&#44; lymphocytic&#44; and neutrophilic infiltrate without eosinophils<br>No signs of vasculitis<br>DIF&#8211;&nbsp;\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">Other diagnostic tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BT &#40;IgE&#44; 260 IU&#47;mL&#59;<br>eosinophils&#44; 0&#46;86 &#215; 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Patch test &#40;negative&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BT&#58;<br>normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BT &#40;glucose&#44; 195<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; GF&#44; 52 mL&#47;min&#59; CBC&#44; normal&#41;&nbsp;\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">Final diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UD &#40;DR secondary to vildagliptin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CSU<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CSU<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UD &#40;DR secondary to silodosin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CSU<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Schnitzler syndrome&nbsp;\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">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Permethrin<br>OA<br>OC<br>TC<br>MTX<br>Vildagliptin &#40;interrupted&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OA<br>OC<br>TC<br><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OA<br>OC<br>NSAIDs &#40;interrupted&#41;<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OA<br>OC<br>TC<br>Silodosin &#40;interrupted&#41;<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Permethrin<br>OA<br>OC<br>TC<br>Montelukast Omalizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OA<br>OC<br>TC<br>MTX&nbsp;\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">Treatment response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Poor<br>&nbsp;\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">Delay between onset and diagnosis&#44; mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\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">Follow-up&#44; mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Case and Research Letters
Urticarial Dermatitis. A Cutaneous Reaction Pattern
Dermatitis urticante. Un patrón de reacción cutánea
M.C. García del Pozoa,
Autor para correspondencia
sakuragarciadelpozo@hotmail.com

Corresponding author.
, I. Povedab, P. Álvarezb, J.F. Silvestreb
a Servicio de Dermatología, Complejo Hospitalario Universitario de Albacete, Albacete, España
b Servicio de Dermatología, Hospital General de Alicante–ISABIAL, Alicante, España
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      "es" => array:1 [
        "titulo" => "Dermatitis urticante&#46; Un patr&#243;n de reacci&#243;n cut&#225;nea"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Excoriated erythematous papules on the back of a patient&#46; B&#44; Use of the Fric test to confirm dermographism on the back of a patient with prurigo lesions at different stages of progression&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2006&#44; Kossard and coworkers coined the term <span class="elsevierStyleItalic">urticarial dermatitis</span> &#40;UD&#41; to describe a histological skin reaction pattern with a broad clinical spectrum&#46; UD is primarily characterized by the presence of urticarial&#44; erythematous&#44; pruritic papules or plaques and eczematous lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Biopsy of urticarial areas reveals a normal stratum corneum&#44; minimal spongiosis&#44; and perivascular lymphocytic infiltrate of the papillary dermis with eosinophils &#40;with or without neutrophils&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In this descriptive observational study we describe the clinical and histological findings in 6 patients with a diagnosis suggestive of UD who were treated at the Eczema Unit of the Dermatology Service of a tertiary hospital in 2015 and 2016&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows corresponding data on epidemiology&#44; comorbidities&#44; clinical presentation&#44; initial clinical suspicion&#44; diagnostic tests&#44; final diagnosis&#44; disease duration at the time of diagnosis&#44; follow-up period&#44; treatment&#44; and progression&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The mean age at UD onset was 70 years &#40;range&#44; 45&#8211;88 years&#41;&#46; None of the patients had a personal or family history of atopy&#44; urticaria&#44; or any other skin disease&#46; All patients reported having pruritus and in all cases physical examination confirmed the presence of urticarial papules or plaques and clinical signs of dermatitis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Dermographism was detected in 4 patients &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; The initial clinical suspicions included UD&#44; chronic spontaneous urticaria &#40;CSU&#41;&#44; bullous pemphigoid&#44; and eczema&#46; Other clinical entities included in the differential diagnosis were drug reactions&#44; urticaria-vasculitis&#44; scabies&#44; and dermatitis herpetiformis&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In all cases&#44; a final diagnosis was established based on the results of diagnostic tests &#40;CSU in 3 patients&#44; drug reaction in 2 patients&#44; and Schnitzler syndrome in 1 patient&#41;&#46; The mean time from disease onset to final diagnosis was 7 months &#40;range&#44; 3&#8211;13 months&#41; and the mean duration of follow-up was 11&#46;3 months &#40;range&#44; 5&#8211;20 months&#41;&#46; All patients were initially treated with oral antihistamines and corticosteroids&#46; Improvement was observed in only 2 patients&#44; both of whom were later diagnosed with CSU&#46; All but 1 patient responded well to targeted treatment once the definitive diagnosis had been established&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">UD is not a discrete disorder&#44; but a group of skin diseases that share similar clinical and histological manifestations&#46; In many patients with clinically suspected UD a clinical-pathological correlation can be reached through accurate diagnostic assessment&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> although this can take several months&#46; Pathologists have used the term <span class="elsevierStyleItalic">dermal hypersensitivity reaction pattern</span> to describe UD&#44; despite the absence of a clinical or histological correlation between these presentations&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;3</span></a> All cases in this series initially posed a diagnostic challenge&#44; as none could be classified as a specific inflammatory disorder&#46; Ultimately&#44; a final diagnosis was established in all cases&#46; The most common diagnosis was CSU&#44; followed by drug reaction&#46; Our results differ from those previously reported in the literature&#58; Kossard and coworkers found that the most frequent clinical associations were eczema and drug reactions&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> while 47&#37; of the cases in the series by Hannon and coworkers were of idiopathic origin&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Certain histological clues may facilitate the establishment of a more specific diagnosis&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> particularly if observed in earlier disease stages when the lesions are more edematous and less excoriated&#46; The presence of spongiosis supports a diagnosis of eczema&#44; while its absence is suggestive of urticaria or lesions secondary to either drug reaction or urticaria&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Because UD can constitute the initial signs of bullous pemphigoid&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> it is advisable to perform direct immunofluorescence studies&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">UD typically affects elderly patients&#44; especially women&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;4</span></a> Because many patients are polymedicated&#44; it can be difficult to identify the causative agent in cases of suspected drug-induced UD&#46; UD lesions have a polymorphous appearance&#44; and exhibit features of urticaria and concomitant or simultaneous dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Eczematous lesions may be caused in part by the use of home remedies to relieve itching&#46; In our study&#44; physical examination revealed dermographism in some patients&#46; Although dermographism is typical of drug reaction&#44; scabies and&#44; above all&#44; CSU&#44; its presence can be particularly helpful in the diagnosis of UD&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">UD may involve a T helper 2 &#40;Th2&#41; lymphocyte reaction&#44; which precedes a dominant T helper 1 &#40;Th1&#41; cytokine profile&#44; particularly in cases of atopic dermatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;5</span></a> This induces the production of interleukin &#40;IL&#41;-4&#44; IL-5&#44; and IL-10&#44; all of which can give rise to eosinophilia and urticarial reactions&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The therapies most commonly used to treat UD include oral antihistamines&#44; topical and systemic corticosteroids&#44; narrowband ultraviolet B radiation&#44; and topical calcineurin inhibitors&#44; usually with unsatisfactory results&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> Some reports have described good responses to treatment with other therapeutic agents&#44; including cyclosporins&#44; mycophenolate mofetil&#44; azathioprine&#44; dapsone&#44; and hydroxyurea&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; UD is a common manifestation of several distinct skin diseases that appear to share a similar pathophysiological mechanism&#46; A final diagnosis can be established after exhaustive evaluation of the information obtained from anamnesis&#44; histology&#44; and other additional tests&#46; The detection of dermographism in the physical examination may help orient the diagnosis towards UD&#46; However&#44; this finding should not be considered a specific sign of any condition in particular&#46; In our opinion&#44; UD is a useful term to describe a skin reaction mainly observed in the elderly&#44; the clinical characteristics of which mimic those of several skin diseases&#46; In many cases&#44; a definitive diagnosis can only be established after long-term follow up&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a del Pozo MC&#44; Poveda I&#44; &#193;lvarez P&#44; Silvestre JF&#46; Dermatitis urticante&#46; Un patr&#243;n de reacci&#243;n cut&#225;nea&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;929&#8211;932&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; BP&#44; bullous pemphigoid&#59; BPH&#44; benign prostatic hyperplasia&#59; BT&#44; blood test&#59; CBC&#44; complete blood count&#59; CSU&#44; chronic spontaneous urticaria&#59; DIF&#44; direct immunofluorescence&#59; DM&#44; diabetes mellitus&#59; DR&#44; drug reaction&#59; GF&#44; glomerular filtrate&#59; MTX&#44; methotrexate&#59; N&#47;A&#44; not applicable&#59; NSAIDs&#44; non-steroidal anti-inflammatory drugs&#59; OA&#44; oral antihistamines&#59; OC&#44; oral corticosteroids&#59; TC&#44; topical corticosteroids&#59; UD&#44; urticarial dermatitis&#59; WM&#44; Waldenstr&#246;m macroglobulinemia&#46;</p>"
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                  <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">Sex&nbsp;\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">Female&nbsp;\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">Male&nbsp;\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">Female&nbsp;\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">Male&nbsp;\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">Female&nbsp;\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">Female&nbsp;\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">Age&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&nbsp;\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">Comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DM<br>Dyslipidemia<br>Essential hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BPH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dyslipidemia<br>DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DM<br>BPH<br>Ischemic heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DM<br>Osteoporosis<br>WM<br>Ovarian teratoma&nbsp;\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">Dermographism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\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">Initial clinical suspicion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Scabies<br>Eczema<br>BP<br>UD<br>CSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BP<br>Eczema<br>UD<br>CSU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UD<br>CSU<br>Urticaria-vasculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Allergic contact dermatitis<br>UD<br>BP<br>DR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Scabies<br>Eczema<br>CSU<br>Dermatitis herpetiformis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CSU<br>Urticaria-vasculitis DR<br>BP&nbsp;\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">Histology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal epidermis<br>Superficial dermal perivascular&#44; lymphocytic&#44; and eosinophilic infiltrate with presence of eosinophils<br>DIF&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Focal parakeratosis&#44; mild eosinophilic spongiosis&#44; and poor vacuolization of the basement membrane Superficial perivascular lymphocytic infiltrate<br>Interstitial lymphocytic and eosinophilic infiltrate<br>DIF&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal epidermis<br>Superficial dermal perivascular&#44; lymphocytic&#44; and eosinophilic infiltrate with interstitial eosinophils<br><br>DIF&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal epidermis<br>Superficial dermal perivascular&#44; lymphocytic&#44; and eosinophilic infiltrate<br>DIF&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal epidermis<br>Superficial dermal perivascular&#44; lymphocytic&#44; and eosinophilic infiltrate with interstitial eosinophils<br>DIF&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal epidermis<br>Mild dermal edema&#44; superficial and interstitial dermal perivascular&#44; lymphocytic&#44; and neutrophilic infiltrate without eosinophils<br>No signs of vasculitis<br>DIF&#8211;&nbsp;\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">Other diagnostic tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BT &#40;IgE&#44; 260 IU&#47;mL&#59;<br>eosinophils&#44; 0&#46;86 &#215; 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Patch test &#40;negative&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BT&#58;<br>normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BT &#40;glucose&#44; 195<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; GF&#44; 52 mL&#47;min&#59; CBC&#44; normal&#41;&nbsp;\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">Final diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UD &#40;DR secondary to vildagliptin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CSU<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CSU<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UD &#40;DR secondary to silodosin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CSU<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Schnitzler syndrome&nbsp;\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">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Permethrin<br>OA<br>OC<br>TC<br>MTX<br>Vildagliptin &#40;interrupted&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OA<br>OC<br>TC<br><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OA<br>OC<br>NSAIDs &#40;interrupted&#41;<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OA<br>OC<br>TC<br>Silodosin &#40;interrupted&#41;<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Permethrin<br>OA<br>OC<br>TC<br>Montelukast Omalizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OA<br>OC<br>TC<br>MTX&nbsp;\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">Treatment response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Poor<br>&nbsp;\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">Delay between onset and diagnosis&#44; mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\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">Follow-up&#44; mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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