Case and Research Letters
Correlation Between Clinical, Histopathologic, and Ultrasound Findings in Focal Acral Hyperkeratosis
Hiperqueratosis acral focal: correlación clínica, histopatológica y ecográfica
Leído
4798
Vecesse ha leído el artículo
1814
Total PDF
2984
Total HTML
Compartir estadísticas
array:23 [ "pii" => "S1578219018303652" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.10.011" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "1907" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:936-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 14 "HTML" => 14 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731018300693" "issn" => "00017310" "doi" => "10.1016/j.ad.2017.12.008" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "1907" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:936-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 248 "formatos" => array:2 [ "HTML" => 196 "PDF" => 52 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICO-CLÍNICA</span>" "titulo" => "Hiperqueratosis acral focal: correlación clínica, histopatológica y ecográfica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "936" "paginaFinal" => "939" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Correlation Between Clinical, Histopathologic, and Ultrasound Findings in Focal Acral Hyperkeratosis" ] ] "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" => 852 "Ancho" => 1517 "Tamanyo" => 454071 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A) Hiperqueratosis ortoqueratósica compacta sobre ligera depresión epidérmica con hipergranulosis (hematoxilina-eosina, ×10). B) Orceína: sin evidencia de elastorrexis ni otras alteraciones dérmicas (orceína, ×20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Company-Quiroga, B. Echeverría, J.C. Tardío, C. Martínez-Morán" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Company-Quiroga" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Echeverría" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Tardío" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Martínez-Morán" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219018303652" "doi" => "10.1016/j.adengl.2018.10.011" "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/S1578219018303652?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018300693?idApp=UINPBA000044" "url" => "/00017310/0000010900000010/v1_201812060614/S0001731018300693/v1_201812060614/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S1578219018303573" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.10.004" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "1974" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:934-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Stewart-Bluefarb Syndrome: Case Report and Review of the Literature" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "934" "paginaFinal" => "936" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Stewart-Bluefarb: caso clínico y revisión de la literatura" ] ] "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" => 1134 "Ancho" => 850 "Tamanyo" => 160094 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image showing raised lesions with perilesional eczema in the anterior pretibial surface and outermost supramalleolar region. An ulcer with perilesional cutaneous hyperpigmentation is visible at the center of the image.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V.E. García Blanco, E. Doiz Artázcoz, M.C. Galera Martínez, M. Rodríguez Piñero" "autores" => array:4 [ 0 => array:2 [ "nombre" => "V.E." "apellidos" => "García Blanco" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Doiz Artázcoz" ] 2 => array:2 [ "nombre" => "M.C." "apellidos" => "Galera Martínez" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Rodríguez Piñero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018302126" "doi" => "10.1016/j.ad.2018.03.019" "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/S0001731018302126?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303573?idApp=UINPBA000044" "url" => "/15782190/0000010900000010/v1_201812060634/S1578219018303573/v1_201812060634/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Correlation Between Clinical, Histopathologic, and Ultrasound Findings in Focal Acral Hyperkeratosis" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "936" "paginaFinal" => "939" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Company-Quiroga, B. Echeverría, J.C. Tardío, C. Martínez-Morán" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Company-Quiroga" "email" => array:1 [ 0 => "j.companyquiroga@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" => "B." "apellidos" => "Echeverría" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.C." "apellidos" => "Tardío" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Martínez-Morán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada (Madrid), España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Fuenlabrada, Fuenlabrada (Madrid), España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperqueratosis acral focal: correlación clínica, histopatológica y ecográfica" ] ] "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" => 982 "Ancho" => 1748 "Tamanyo" => 241374 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A-C, Minute symmetrically arranged flesh-colored hyperpigmented papules with a shiny surface that is lichenoid in appearance, some of which are umbilicated. D) Hyperpigmentation of the interphalangeal joints with characteristic lesions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 38-year-old woman (skin type V) with a history of tricuspid and mitral regurgitation who had undergone pulmonary bilobectomy for atypical carcinoid tumor. She was taking oral contraceptives. She attended our center with a flare-up of pruriginous lesions on her hands and forearms that had first appeared 1 year previously. The lesions appeared every month and did not remit completely between flare-ups, although they did improve with medium-potency topical corticosteroids. She reported no lesions at other sites and denied having had concomitant symptoms. Physical examination revealed poorly defined, apparently residual erythematous-brownish macules on the anterior and lateral surfaces of the wrists. Multiple hyperpigmented papules with a shiny surface measuring between 1 mm and 3<span class="elsevierStyleHsp" style=""></span>mm in diameter were observed on the radial surface of the first finger of both hands and on the palmar creases. These alternated with flesh-colored papules with a lichenoid appearance on the adjacent skin and were distributed symmetrically (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). An ultrasound scan (Esaote, MyLabClass C with a 22-MHz transducer) of the affected area on the lateral surface of the wrist revealed epidermal thickening in the form of a cleft, which was observed as double hyperechoic band with a hypoechoic central area. The upper band was characterized by undulations that varied between more hyperechoic areas (convex) and more hypoechoic areas (concave) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Ultrasound revealed a certain degree of hypoechogenicity in the dermis that was interpreted as an artifact resulting from epidermal thickening using the 22-MHz transducer. The suspicion of lichen nitidus compared with elastic fiber abnormality led us to perform a biopsy of the ultrasound lesion and to prescribe clobetasol cream. Histopathology revealed a compact area of orthokeratotic hyperkeratosis resting on a slight epidermal depression with mild hypergranulosis in the epidermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). No inflammation or other significant histopathological abnormalities were observed. Orcein staining did not reveal elastorrhexis. Therefore, the findings were compatible with focal acral hyperkeratosis (FAH)–type marginal papular acrokeratoderma. At subsequent visits, the patient reported a lack of improvement with her daily high-potency corticosteroid and even mentioned the appearance of additional lesions; consequently, we recommended a switch to mometasone and calcipotriol cream.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">FAH is an uncommon variant of a heterogeneous group of conditions grouped together under the term <span class="elsevierStyleItalic">palmoplantar keratoderma</span>, which are characterized by chronic pathologic thickening of the hairless skin of the palms and soles secondary to hyperkeratosis. Until 1983, there had been multiple reports of hyperkeratotic papular lesions on the lateral sides of the hands and feet. Their clinical presentation was similar to that of a condition previously known as acrokeratoelastoidosis,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> and the histology findings were similar, except for the absence of elastorrhexis. This is when Dowd et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> coined the term <span class="elsevierStyleItalic">focal acral hyperkeratosis</span> to define a new entity whose differentiation with acrokeratoelastoidosis continues to be controversial. Those authors who see the conditions as separate entities believe that the first is a focal keratinization disorder, whereas the second is based on abnormalities of the elastic fibers. Their claims are supported by the histologic nuance of elastorrhexis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> In 1994, Rongioletti et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> proposed grouping these 2<span class="elsevierStyleHsp" style=""></span>entities and other clinically indistinguishable conditions under the term <span class="elsevierStyleItalic">marginal papular acrokeratoderma</span>. In 2009, Martínez-Casimiro et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> reported a new FAH-type case, similar to the one we report here. The patient was a black woman in the third decade of life with asymptomatic lesions on the palms and lateral surfaces of the hands that had first appeared several years previously. The authors studied the article by Dowd et al., who reported on familial cases (autosomal dominant inheritance pattern<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a>). The typical histology pattern is invariably characterized by orthokeratotic hyperkeratosis on an epidermal depression, with no abnormalities of collagen or elastic fibers. Lee and Kim<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> examined biopsy specimens of lesional and healthy skin and performed immunohistochemical staining of proliferation and differentiation markers (Ki-67/proliferating cell nuclear antigen and involucrin, respectively). In addition to a 3.4-fold increase in the thickness of the orthokeratotic layer and a 2-fold increase in the thickness of the epidermis, the authors reported increased levels for both markers, thus supporting the possibility that FAH is a focal disorder of keratinization in which the process is accelerated.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In addition to the histology findings, we reported the ultrasound characteristics of the condition, which involved a specific epidermal cleft with marked changes in echogenicity and no abnormalities in the dermis. No abnormalities of the healthy skin were observed (the marked difference in the thickness of the epidermis can be seen in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). To date, diagnosis of FAH has been based on characteristic symptoms with consistent demographic data and a potentially compatible family history, as well as on the absence of dermal abnormalities in histology. The finding of the ultrasound characteristics used in the differential diagnosis<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> of FAH (acrokeratoelastoidosis itself, plane warts, acrokeratosis verruciformis, punctate porokeratosis, punctate palmoplantar keratoderma, palmoplantar lichen planus, and juvenile elastoma) could be essential for determining the role of ultrasound in the differential diagnosis of these conditions. The main limitation is the low number of cases and, therefore, the difficulty in matching with similar clinical presentations in the various conditions that manifest as palmoplantar keratoderma. There is no evidence to support treating FAH, which often proves to be ineffective: given the absence of symptoms, not treating is a reasonable option.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We report the first ultrasound description of FAH as an additional diagnostic tool in the study of palmoplantar keratoderma.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Company-Quiroga J, Echeverría B, Tardío JC, Martínez-Morán C. Hiperqueratosis acral focal: correlación clínica, histopatológica y ecográfica. Actas Dermosifiliogr. 2018;109:936–939.</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" => 982 "Ancho" => 1748 "Tamanyo" => 241374 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A-C, Minute symmetrically arranged flesh-colored hyperpigmented papules with a shiny surface that is lichenoid in appearance, some of which are umbilicated. D) Hyperpigmentation of the interphalangeal joints with characteristic lesions.</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" => 960 "Ancho" => 1517 "Tamanyo" => 110141 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Upper trace, epidermis; middle trace, dermis; lower trace, subcutaneous cellular tissue. Lesional skin (left): cleft in the epidermis seen as a double hyperechoic band with a hypoechoic central area on a somewhat hypoechoic dermis (possible artifact secondary to variability in epidermal thickening). Upper band: undulation that alternates between more hyperechoic areas (convex) and more hypoechoic areas (concave). Healthy skin (right): epidermis with no abnormalities in the form of a fine homogeneous hyperechoic band.</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" => 852 "Ancho" => 1517 "Tamanyo" => 454201 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Compact orthokeratotic hyperkeratosis resting on a slight epidermal depression with hypergranulosis (hematoxylin-eosin, original magnification, ×10). B, Orcein staining, with no evidence of elastorrhexis or other dermal alterations (orcein, original magnification, ×20).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acrokeratoelastoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "O. Costa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1954" "volumen" => "70" "paginaInicial" => "228" "paginaFinal" => "231" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focal acral hyperkeratosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Dowd" 1 => "R. Harman" 2 => "M. Black" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1983" "volumen" => "109" "paginaInicial" => "97" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6222757" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focal acral hyperkeratosis and acrokeratoelastoidosis: Birds of a feather?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.A. Van Steensel" 1 => "J. Frank" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2008.03084.x" "Revista" => array:6 [ "tituloSerie" => "JEADV" "fecha" => "2009" "volumen" => "23" "paginaInicial" => "1092" "paginaFinal" => "1115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19207659" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Marginal popular acrokeratodermas: A unified nosography for focal acral hyperkeratosis, acrokeratoelastoidosis and related disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Rongioletti" 1 => "R. Betti" 2 => "C. Crosti" 3 => "A. Rebora" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000247081" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "1994" "volumen" => "188" "paginaInicial" => "28" "paginaFinal" => "31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8305752" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pápulas hiperqueratósicas en las manos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Martínez-Casimiro" 1 => "V. Zaragoza" 2 => "J.L. Sánchez-Carazo" 3 => "V. Alegre" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2009" "volumen" => "100" "paginaInicial" => "73" "paginaFinal" => "74" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperqueratosis acral focal asociada a queratolisis punteada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.D. López-Cepeda" 1 => "L. Alonzo" 2 => "G. Navarrete" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2005" "volumen" => "96" "paginaInicial" => "37" "paginaFinal" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16476330" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focal acral hyperkeratosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.E. Lee" 1 => "S.C. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2230.2007.02439.x" "Revista" => array:7 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "608" "paginaFinal" => "610" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17524070" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0959804913003596" "estado" => "S300" "issn" => "09598049" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Zanini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Focal acral hyperkeratosis: Case report and discussion on marginal keratodermas An Bras Dermatol." "fecha" => "2006" "volumen" => "81" "paginaInicial" => "S293" "paginaFinal" => "S296" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focal acral hyperkeratosis: A rare cutaneous disorder within the spectrum of Costa acrokeratoelastoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Erkek" 1 => "M. Kocak" 2 => "O. Bozdogan" 3 => "P. Atasoy" 4 => "A. Birol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.0736-8046.2004.21208.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2004" "volumen" => "21" "paginaInicial" => "128" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15078352" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000010/v1_201812060634/S1578219018303652/v1_201812060634/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/15782190/0000010900000010/v1_201812060634/S1578219018303652/v1_201812060634/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303652?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 7 | 12 |
| 2024 Octubre | 68 | 54 | 122 |
| 2024 Septiembre | 92 | 24 | 116 |
| 2024 Agosto | 110 | 82 | 192 |
| 2024 Julio | 78 | 56 | 134 |
| 2024 Junio | 80 | 49 | 129 |
| 2024 Mayo | 79 | 35 | 114 |
| 2024 Abril | 81 | 38 | 119 |
| 2024 Marzo | 78 | 34 | 112 |
| 2024 Febrero | 62 | 42 | 104 |
| 2024 Enero | 63 | 33 | 96 |
| 2023 Diciembre | 68 | 20 | 88 |
| 2023 Noviembre | 71 | 26 | 97 |
| 2023 Octubre | 66 | 27 | 93 |
| 2023 Septiembre | 66 | 34 | 100 |
| 2023 Agosto | 54 | 21 | 75 |
| 2023 Julio | 68 | 39 | 107 |
| 2023 Junio | 54 | 24 | 78 |
| 2023 Mayo | 52 | 30 | 82 |
| 2023 Abril | 36 | 23 | 59 |
| 2023 Marzo | 55 | 43 | 98 |
| 2023 Febrero | 37 | 27 | 64 |
| 2023 Enero | 38 | 26 | 64 |
| 2022 Diciembre | 68 | 43 | 111 |
| 2022 Noviembre | 61 | 29 | 90 |
| 2022 Octubre | 63 | 26 | 89 |
| 2022 Septiembre | 66 | 53 | 119 |
| 2022 Agosto | 76 | 44 | 120 |
| 2022 Julio | 66 | 40 | 106 |
| 2022 Junio | 26 | 28 | 54 |
| 2022 Mayo | 68 | 40 | 108 |
| 2022 Abril | 90 | 41 | 131 |
| 2022 Marzo | 47 | 48 | 95 |
| 2022 Febrero | 52 | 31 | 83 |
| 2022 Enero | 67 | 38 | 105 |
| 2021 Diciembre | 57 | 36 | 93 |
| 2021 Noviembre | 50 | 35 | 85 |
| 2021 Octubre | 53 | 55 | 108 |
| 2021 Septiembre | 51 | 48 | 99 |
| 2021 Agosto | 47 | 48 | 95 |
| 2021 Julio | 28 | 32 | 60 |
| 2021 Junio | 36 | 22 | 58 |
| 2021 Mayo | 46 | 44 | 90 |
| 2021 Abril | 87 | 37 | 124 |
| 2021 Marzo | 43 | 20 | 63 |
| 2021 Febrero | 55 | 18 | 73 |
| 2021 Enero | 31 | 14 | 45 |
| 2020 Diciembre | 23 | 19 | 42 |
| 2020 Noviembre | 14 | 11 | 25 |
| 2020 Octubre | 20 | 11 | 31 |
| 2020 Septiembre | 25 | 25 | 50 |
| 2020 Agosto | 14 | 21 | 35 |
| 2020 Julio | 16 | 14 | 30 |
| 2020 Junio | 21 | 18 | 39 |
| 2020 Mayo | 10 | 12 | 22 |
| 2020 Abril | 19 | 12 | 31 |
| 2020 Marzo | 11 | 5 | 16 |
| 2020 Febrero | 2 | 2 | 4 |
| 2019 Junio | 3 | 0 | 3 |
| 2019 Abril | 9 | 0 | 9 |
| 2019 Febrero | 1 | 0 | 1 |
| 2019 Enero | 1 | 0 | 1 |
Mostrar todo
