array:24 [
  "pii" => "S1578219018304414"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2018.12.005"
  "estado" => "S300"
  "fechaPublicacion" => "2019-03-01"
  "aid" => "1984"
  "copyright" => "Elsevier España, S.L.U. and AEDV"
  "copyrightAnyo" => "2018"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2019;110:167-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5
    "formatos" => array:2 [
      "HTML" => 3
      "PDF" => 2
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731018302485"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2017.12.015"
      "estado" => "S300"
      "fechaPublicacion" => "2019-03-01"
      "aid" => "1984"
      "copyright" => "AEDV"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2019;110:167-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 252
        "formatos" => array:2 [
          "HTML" => 166
          "PDF" => 86
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta cient&#237;fico-cl&#237;nica</span>"
        "titulo" => "Histiocitosis de c&#233;lulas de Langerhans cut&#225;nea de presentaci&#243;n en el adulto"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "167"
            "paginaFinal" => "169"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Cutaneous Langerhans Cell Histiocytosis Presenting in Adulthood"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 694
                "Ancho" => 2083
                "Tamanyo" => 240294
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a&#41; Lesi&#243;n papular levemente eritematosa localizada en borde lateral de ceja derecha&#59; b&#41; P&#225;pula eritematosa en antebrazo izquierdo&#59; c&#41; Placa levemente eritematosa localizada en cuello lateral izquierdo&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46;A&#46; Flores-Terry, J&#46;L&#46; Sanz-Trenado, M&#46; Garc&#237;a-Arpa, M&#46;P&#46; Cortina-de la Calle"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "M&#46;A&#46;"
                "apellidos" => "Flores-Terry"
              ]
              1 => array:2 [
                "nombre" => "J&#46;L&#46;"
                "apellidos" => "Sanz-Trenado"
              ]
              2 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Garc&#237;a-Arpa"
              ]
              3 => array:2 [
                "nombre" => "M&#46;P&#46;"
                "apellidos" => "Cortina-de la Calle"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219018304414"
          "doi" => "10.1016/j.adengl.2018.12.005"
          "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/S1578219018304414?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018302485?idApp=UINPBA000044"
      "url" => "/00017310/0000011000000002/v1_201903070622/S0001731018302485/v1_201903070622/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219019300071"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2019.01.005"
    "estado" => "S300"
    "fechaPublicacion" => "2019-03-01"
    "aid" => "1928"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2019;110:169-71"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8
      "formatos" => array:2 [
        "HTML" => 7
        "PDF" => 1
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Nail Psoriasis Treated With Certolizumab Pegol in Patients With Psoriatic Arthritis&#58; Preliminary Observation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "169"
          "paginaFinal" => "171"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Psoriasis ungueal tratada con certolizumab pegol en pacientes con artritis psori&#225;sica&#58; conclusi&#243;n preliminar"
        ]
      ]
      "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" => 867
              "Ancho" => 1500
              "Tamanyo" => 56926
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nail Psoriasis Severity Index graph&#46; W indicates week&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Mazzeo, A&#46; Dattola, M&#46;V&#46; Cannizzaro, L&#46; Bianchi"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Mazzeo"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Dattola"
            ]
            2 => array:2 [
              "nombre" => "M&#46;V&#46;"
              "apellidos" => "Cannizzaro"
            ]
            3 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Bianchi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731018300905"
        "doi" => "10.1016/j.ad.2018.02.010"
        "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/S0001731018300905?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019300071?idApp=UINPBA000044"
    "url" => "/15782190/0000011000000002/v1_201903030657/S1578219019300071/v1_201903030657/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219018304451"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2018.12.007"
    "estado" => "S300"
    "fechaPublicacion" => "2019-03-01"
    "aid" => "1966"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2019;110:164-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1
      "HTML" => 1
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Tuberous Sclerosis Complex Associated with Hemihypertrophy and Combined Vascular Malformations"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "164"
          "paginaFinal" => "167"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Complejo de esclerosis tuberosa asociado a hemihipertrofia y malformaciones vasculares combinadas"
        ]
      ]
      "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" => 1606
              "Ancho" => 2336
              "Tamanyo" => 253375
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Limb asymmetry with overgrowth of the left arm&#46; B and C&#44; Capillary and venous vascular malformations on the anterior and posterior aspects of the arm&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;&#193;&#46; Flores-Terry, A&#46; Alegre-S&#225;nchez, P&#46; Boixeda, J&#46;C&#46; L&#243;pez-Guti&#233;rrez"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "Flores-Terry"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Alegre-S&#225;nchez"
            ]
            2 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Boixeda"
            ]
            3 => array:2 [
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "L&#243;pez-Guti&#233;rrez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731018302047"
        "doi" => "10.1016/j.ad.2017.12.010"
        "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/S0001731018302047?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018304451?idApp=UINPBA000044"
    "url" => "/15782190/0000011000000002/v1_201903030657/S1578219018304451/v1_201903030657/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
    "titulo" => "Cutaneous Langerhans Cell Histiocytosis Presenting in Adulthood"
    "tieneTextoCompleto" => true
    "saludo" => "To the Editor&#58;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "167"
        "paginaFinal" => "169"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46;A&#46; Flores-Terry, J&#46;L&#46; Sanz-Trenado, M&#46; Garc&#237;a-Arpa, M&#46;P&#46; Cortina-de la Calle"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "M&#46;A&#46;"
            "apellidos" => "Flores-Terry"
            "email" => array:1 [
              0 => "miguelterry85&#64;hotmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "J&#46;L&#46;"
            "apellidos" => "Sanz-Trenado"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Garc&#237;a-Arpa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "M&#46;P&#46;"
            "apellidos" => "Cortina-de la Calle"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital General Universitario de Ciudad Real&#44; Ciudad Real&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Anatom&#237;a Patol&#243;gica&#44; Hospital General Universitario de Ciudad Real&#44; Ciudad Real&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Histiocitosis de c&#233;lulas de Langerhans cut&#225;nea de presentaci&#243;n en el adulto"
      ]
    ]
    "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" => 1624
            "Ancho" => 2106
            "Tamanyo" => 648374
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Dense&#44; nodular-type infiltrate in the dermis&#44; with areas of necrosis&#59; hematoxylin-eosin&#44; magnification &#215;10&#41;&#46; B&#44; Histiocytes with oval or kidney-shaped nuclei resembling coffee beans and clear cytoplasm&#59; accompanied by lymphocytes and eosinophils &#40;hematoxylin-eosin&#44; magnification &#215;20&#41;&#46; C and D&#44; immunohistochemical staining was positive for S100 and CD1a&#44; respectively&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Langerhans cell histiocytosis &#40;LCH&#41; is a disease of clonal proliferation of immature Langerhans cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> LCH can affect any organ&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> occurs mainly in children&#44; and is rare in adults&#46; It is even rarer for it to be confined to the skin&#46; We present 3 cases of adult-onset cutaneous LCH treated by surgical excision&#46; No new lesions or systemic or other effects developed during follow-up&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 1&#58;</span> A 36-year-old man with no relevant medical history presented with an asymptomatic lesion that had appeared 2 months earlier&#46; It was located on the external edge of the right eyebrow&#44; and there were no associated symptoms&#46; Physical examination showed it to be a papule 6<span class="elsevierStyleHsp" style=""></span>mm in diameter that was slightly erythematous&#44; firm to the touch&#44; and well defined &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; No other skin or mucosal lesions&#44; palpable lymph nodes&#44; or enlarged organs were detected&#46; Histopathology of the excised tissue revealed a normal epidermis and a dense&#44; nodular-type infiltrate &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41; composed of dispersed cells with oval or kidney-shaped nuclei resembling coffee beans &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; The cells had a clear eosinophilic cytoplasm&#44; corresponding to histiocytes&#46; The infiltrate also contained necrotic areas&#44; lymphocytes&#44; and eosinophils&#46; The mitotic index was very low&#46; Immunohistochemical staining was positive for S100&#44; CD1a &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C and 2D&#41; and CD207 &#40;langerin&#41; and negative for CD68&#46; With these findings we made the diagnosis of LCH and ordered the following additional tests and imaging studies&#58; complete blood count&#44; coagulation screen&#44; biochemistry&#44; hormone profile&#44; urine analysis&#44; chest radiograph&#44; abdominal ultrasound&#44; and bone scans&#46; All findings were normal&#46; The final diagnosis was adult-onset LCH confined to the skin&#46; The patient has remained asymptomatic for 3 years&#46; No new skin lesions&#44; systemic symptoms&#44; or related disorders have developed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 2&#58;</span> A 33-year-old woman reported that an asymptomatic lesion had appeared on her left forearm 6 months earlier&#46; It was an erythematous&#44; infiltrated papule 5<span class="elsevierStyleHsp" style=""></span>mm in diameter &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; No enlarged lymph nodes or organs were found on physical examination&#46; The lesion was removed&#44; and the histopathologic findings&#44; similar to those described in the first case&#44; were consistent with a diagnosis of LCH&#46; The results of additional tests were negative&#44; and no new lesions or other clinical or analytic abnormalities have appeared in 2 years of follow-up&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 3&#58;</span> A 49-year-old woman presented with 2 erythematous&#44; papular lesions 5<span class="elsevierStyleHsp" style=""></span>and 7<span class="elsevierStyleHsp" style=""></span>mm in diameter located on her right cheek and back&#46; She also had a 9-mm plaque on the left side of her neck &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; No abnormalities were found on physical examination&#46; Histopathology of an excised lesion was consistent with LCH&#44; and so the remaining two were also removed&#46; The histologic findings were the same&#46; Additional studies gave no positive results&#46; No new lesions or new conditions have developed in 3 years of follow-up&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">LCH is a rare disease that is diagnosed mainly in children under the age of 15 years&#46; Over that age&#44; the estimated incidence is 5<span class="elsevierStyleHsp" style=""></span>to 9<span class="elsevierStyleHsp" style=""></span>cases per million population&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;4</span></a> The spectrum of clinical presentations ranges widely&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;6</span></a> varying according to the organ affected&#46; In some cases lesions are solitary and resolve on their own&#44; whereas in others the disease is disseminated and life-threatening&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4&#44;6&#44;10</span></a> The recent classification system of the Histiocyte Society refers specifically to a Langerhans &#40;L&#41; group of diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Diagnosis is based on clinical&#44; radiologic&#44; and histopathologic findings&#44; the last of which identifies a histiocytic infiltrate with the characteristic immunophenotypic features of LCH&#46; The disease can affect any organ but is mainly found in bones&#44; skin&#44; hypophysis&#44; liver&#44; spleen&#44; lymph glands&#44; and lungs&#59; less often&#44; the central nervous &#40;other than at the hypophysis&#41; and hematopoietic systems are involved&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The pathogenesis of LCH remains unclear&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4&#44;6&#44;7</span></a> The <span class="elsevierStyleItalic">BRAF</span> V600E mutation&#44; which overstimulates the MAPK pathway&#44; is present in half of patients with LCH&#46; Smaller proportions of patients carry the <span class="elsevierStyleItalic">MAP2K1</span> MEK1 or <span class="elsevierStyleItalic">MAP3K1</span> ARF mutations&#46; Mutations in the <span class="elsevierStyleItalic">PICK1</span> and <span class="elsevierStyleItalic">PICK3R2</span> genes&#44; affecting the PIK3CA pathway&#44; have also been described&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> These findings support the theory that LCH is a neoplastic process&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; the inflammatory component and the fact that the clinical course is sometimes benign suggest a reactive process&#46; Cases of familial LCH have been reported&#44; though no genetic predisposition has yet been identified&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Adult-onset LCH confined to the skin is very rare&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;5&#44;8</span></a> This form may present as a solitary papular or nodular lesion&#44; with or without ulceration&#44; or as multiple lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;9</span></a> It may even mimic other skin diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> In a series of 18 patients who presented with cutaneous lesions&#44; the ages ranged from 20 to 89 years and no pattern related to race or gender was identified&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Nearly half &#40;8&#47;18&#41; had solitary lesions &#40;papules or nodules&#41; or ulcerated lesions in skin folds&#46; On further study&#44; bone involvement was found in 1 of these patients and myelodysplastic syndrome was diagnosed in 2 of them&#46; During a mean follow-up period of 41 months&#44; 2 patients developed noncutaneous LCH and 5 patients were diagnosed with progressing blood tumors &#40;2 cases of myelomonocytic leukemia and 1 case each of histiocytic sarcoma&#44; diffuse large B-cell lymphoma&#44; and peripheral T-cell lymphoma&#41;&#46; The authors of that series also reviewed the literature&#44; finding 74 patients with initial presentations involving the skin&#44; 4 of whom had extended histiocytosis and 8 of whom had blood diseases found during diagnosis or follow-up&#46; The authors suggested that the association between LCH and myelomonocytic disorders could be related to the common origin of the cells in bone marrow&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> LCH is currently thought to arise in myeloid dendritic cells of the bone marrow&#44; which express the same antigens as cutaneous Langerhans cells&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The differential diagnosis of LCH includes several neoplastic and inflammatory diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Knowledge of the lesions&#8217; immunophenotype is therefore essential for a firm diagnosis&#46; Histology must demonstrate an infiltrate of Langerhans cells positive for CD1a and&#47;or CD207 &#40;langerin&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;6</span></a> a criterion that has replaced the finding of Birbeck granules by electron microscopy&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Positive staining for CD207 rules out indeterminate cell histiocytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Searching for possible extension of disease to other tissues and follow-up are essential when treating adults with skin lesions to rule out LCH in other locations and concurrent conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;6</span></a> Findings will be mainly blood disorders&#44; such as typically occur in children&#46; Tests and imaging studies recommended for adults with LCH include a complete blood count&#44; biochemistry&#44; chest radiograph&#44; hormone profile&#44; bone scans&#44; and abdominal ultrasound&#59; these studies are ordered at baseline and every 6 months during follow-up for asymptomatic patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3</span></a> A full physical examination&#44; complete blood count and biochemistry&#44; and abdominal ultrasound as well as a chest radiograph are usually ordered annually for at least 3 years&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Bone marrow should be biopsied if infiltration is suspected&#44; although some authors believe the procedure should be routine&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Because LCH in the adult is so rare&#44; optimum treatment has not been established&#46; The prognosis is good for patients with LCH confined to a single organ or system&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;6</span></a> but they should be followed closely&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;10</span></a> Local treatments &#40;surgery&#44; topical corticosteroids&#44; or corticosteroid infiltrations&#41; can be used&#46; Multiple&#44; ulcerated&#44; or resistant lesions can be treated with systemic corticosteroids&#44; phototherapy&#44; radiotherapy&#44; interferon&#44; and various chemotherapeutic regimens&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;9</span></a> It has been suggested that ulceration may affect the prognosis&#44; although to date the reported outcomes have been inconsistent&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:3 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of Interest"
        ]
        1 => array:2 [
          "identificador" => "xack395547"
          "titulo" => "Acknowledgments"
        ]
        2 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-08-01"
    "fechaAceptado" => "2017-12-26"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Flores-Terry MA&#44; Sanz-Trenado JL&#44; Garc&#237;a-Arpa M&#44; Cortina-de la Calle MP&#46; Cutaneous Langerhans Cell Histiocytosis Presenting in Adulthood&#46; Actas Dermosifiliogr&#46;2019&#59;110&#58;167&#8211;169&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 686
            "Ancho" => 2083
            "Tamanyo" => 238090
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Slightly erythematous papular lesion at the edge of the right eyebrow&#46; B&#44; Erythematous lesion on the left forearm&#46; C&#44; Slightly erythematous plaque on the left side of the neck&#46;</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" => 1624
            "Ancho" => 2106
            "Tamanyo" => 648374
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Dense&#44; nodular-type infiltrate in the dermis&#44; with areas of necrosis&#59; hematoxylin-eosin&#44; magnification &#215;10&#41;&#46; B&#44; Histiocytes with oval or kidney-shaped nuclei resembling coffee beans and clear cytoplasm&#59; accompanied by lymphocytes and eosinophils &#40;hematoxylin-eosin&#44; magnification &#215;20&#41;&#46; C and D&#44; immunohistochemical staining was positive for S100 and CD1a&#44; respectively&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Langerhans cell histiocytosis first presenting in the skin in adults&#58; Frequent association with a second haematological malignancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;R&#46; Edelbroek"
                            1 => "M&#46;H&#46; Vermeer"
                            2 => "P&#46;M&#46; Jansen"
                            3 => "T&#46;J&#46; Stoof"
                            4 => "M&#46;M&#46; van der Linden"
                            5 => "B&#46; Horv&#225;th"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2012.11169.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2012"
                        "volumen" => "167"
                        "paginaInicial" => "1287"
                        "paginaFinal" => "1294"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22835048"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Descriptive epidemiology of childhood Langerhans cell histiocytosis in France&#44; 2000-2004"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Guyot-Goubin"
                            1 => "J&#46; Donadieu"
                            2 => "M&#46; Barkaoui"
                            3 => "S&#46; Bellec"
                            4 => "C&#46; Thomas"
                            5 => "J&#46; Clavel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Blood Cancer"
                        "fecha" => "2008"
                        "volumen" => "1"
                        "paginaInicial" => "3"
                        "paginaFinal" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Management of adult patients with Langerhans cell histiocytosis&#58; Recommendations from a expert panel on behalf of Euro-Histio-Net"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Girschikofsky"
                            1 => "M&#46; Arico"
                            2 => "D&#46; Castillo"
                            3 => "A&#46; Chu"
                            4 => "C&#46; Doberauer"
                            5 => "J&#46; Fichter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Orphanet J Rare Dis&#46;"
                        "fecha" => "2013"
                        "volumen" => "14"
                        "paginaInicial" => "72"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revised classification of histiocytoses and neoplasms of the macrophage-dendritic cell lineages"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Histiocyte Society"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Emile"
                            1 => "O&#46; Abla"
                            2 => "S&#46; Fraitag"
                            3 => "A&#46; Horne"
                            4 => "J&#46; Haroche"
                            5 => "J&#46; Donadieu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/blood-2016-01-690636"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood"
                        "fecha" => "2016"
                        "volumen" => "127"
                        "paginaInicial" => "2672"
                        "paginaFinal" => "2681"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26966089"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Langerhans cell histiocytosis in adults&#58; A case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Lian"
                            1 => "Y&#46; Lu"
                            2 => "S&#46; Shen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.18632/oncotarget.7892"
                      "Revista" => array:6 [
                        "tituloSerie" => "Oncotarget"
                        "fecha" => "2016"
                        "volumen" => "7"
                        "paginaInicial" => "18678"
                        "paginaFinal" => "18683"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26942568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Self-limiting cutaneous Langerhans cells histiocytosis in an adult&#46; A case report and a review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46; Mart&#237;nez-Ortiz"
                            1 => "M&#46;D&#46; Mu&#241;oz S&#225;nchez-Reyes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Patol"
                        "fecha" => "2015"
                        "volumen" => "48"
                        "paginaInicial" => "57"
                        "paginaFinal" => "60"
                        "itemHostRev" => array:3 [
                          "pii" => "S1054139X17304056"
                          "estado" => "S300"
                          "issn" => "1054139X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathogenesis of Langerhans cell histiocytosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Badalian-Very"
                            1 => "J&#46;A&#46; Vergilio"
                            2 => "M&#46; Fleming"
                            3 => "B&#46;J&#46; Rollins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1146/annurev-pathol-020712-163959"
                      "Revista" => array:6 [
                        "tituloSerie" => "Annu Rev Pathol"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "1"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22906202"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Langerhans cell histiocytosis in adults&#46; Report from the International Registry of the Histiocyte Society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Aric&#243;"
                            1 => "M&#46; Girschikofsky"
                            2 => "T&#46; G&#233;n&#233;reau"
                            3 => "C&#46; Klersy"
                            4 => "K&#46; McClain"
                            5 => "N&#46; Grois"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cancer"
                        "fecha" => "2003"
                        "volumen" => "39"
                        "paginaInicial" => "2341"
                        "paginaFinal" => "2348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14556926"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adult Langerhans cell histiocytosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; De Menthon"
                            1 => "V&#46; Meignin"
                            2 => "A&#46; Mahr"
                            3 => "A&#46; Tazi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.lpm.2016.09.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Presse Med"
                        "fecha" => "2017"
                        "volumen" => "46"
                        "paginaInicial" => "55"
                        "paginaFinal" => "69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27816338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Erythroderma as an initial presentation of Langerhans cell histiocytosis involving the sinus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Ruiz-Villaverde"
                            1 => "M&#46; Gal&#225;n-Gutierrez"
                            2 => "F&#46; Ramos-Pleguezuelos"
                            3 => "J&#46;M&#46; Martinez de Victoria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2013.08.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2014"
                        "volumen" => "105"
                        "paginaInicial" => "630"
                        "paginaFinal" => "632"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24139467"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack395547"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">Drs Juan Luis Santiago S&#225;nchez-Mateos and Claudia Ramos-Rodr&#237;guez collaborated in preparing this report&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000011000000002/v1_201903030657/S1578219018304414/v1_201903030657/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/15782190/0000011000000002/v1_201903030657/S1578219018304414/v1_201903030657/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018304414?idApp=UINPBA000044"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Case and Research Letters
Cutaneous Langerhans Cell Histiocytosis Presenting in Adulthood
Histiocitosis de células de Langerhans cutánea de presentación en el adulto
M.A. Flores-Terrya,
Autor para correspondencia
miguelterry85@hotmail.com

Corresponding author.
, J.L. Sanz-Trenadob, M. García-Arpaa, M.P. Cortina-de la Callea
a Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
b Servicio de Anatomía Patológica, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
Leído
7788
Veces
se ha leído el artículo
1915
Total PDF
5873
Total HTML
Compartir estadísticas
 array:24 [
  "pii" => "S1578219018304414"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2018.12.005"
  "estado" => "S300"
  "fechaPublicacion" => "2019-03-01"
  "aid" => "1984"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
  "copyrightAnyo" => "2018"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2019;110:167-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5
    "formatos" => array:2 [
      "HTML" => 3
      "PDF" => 2
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731018302485"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2017.12.015"
      "estado" => "S300"
      "fechaPublicacion" => "2019-03-01"
      "aid" => "1984"
      "copyright" => "AEDV"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2019;110:167-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 252
        "formatos" => array:2 [
          "HTML" => 166
          "PDF" => 86
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta cient&#237;fico-cl&#237;nica</span>"
        "titulo" => "Histiocitosis de c&#233;lulas de Langerhans cut&#225;nea de presentaci&#243;n en el adulto"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "167"
            "paginaFinal" => "169"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Cutaneous Langerhans Cell Histiocytosis Presenting in Adulthood"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 694
                "Ancho" => 2083
                "Tamanyo" => 240294
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a&#41; Lesi&#243;n papular levemente eritematosa localizada en borde lateral de ceja derecha&#59; b&#41; P&#225;pula eritematosa en antebrazo izquierdo&#59; c&#41; Placa levemente eritematosa localizada en cuello lateral izquierdo&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46;A&#46; Flores-Terry, J&#46;L&#46; Sanz-Trenado, M&#46; Garc&#237;a-Arpa, M&#46;P&#46; Cortina-de la Calle"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "M&#46;A&#46;"
                "apellidos" => "Flores-Terry"
              ]
              1 => array:2 [
                "nombre" => "J&#46;L&#46;"
                "apellidos" => "Sanz-Trenado"
              ]
              2 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Garc&#237;a-Arpa"
              ]
              3 => array:2 [
                "nombre" => "M&#46;P&#46;"
                "apellidos" => "Cortina-de la Calle"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219018304414"
          "doi" => "10.1016/j.adengl.2018.12.005"
          "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/S1578219018304414?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018302485?idApp=UINPBA000044"
      "url" => "/00017310/0000011000000002/v1_201903070622/S0001731018302485/v1_201903070622/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219019300071"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2019.01.005"
    "estado" => "S300"
    "fechaPublicacion" => "2019-03-01"
    "aid" => "1928"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2019;110:169-71"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8
      "formatos" => array:2 [
        "HTML" => 7
        "PDF" => 1
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Nail Psoriasis Treated With Certolizumab Pegol in Patients With Psoriatic Arthritis&#58; Preliminary Observation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "169"
          "paginaFinal" => "171"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Psoriasis ungueal tratada con certolizumab pegol en pacientes con artritis psori&#225;sica&#58; conclusi&#243;n preliminar"
        ]
      ]
      "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" => 867
              "Ancho" => 1500
              "Tamanyo" => 56926
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nail Psoriasis Severity Index graph&#46; W indicates week&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Mazzeo, A&#46; Dattola, M&#46;V&#46; Cannizzaro, L&#46; Bianchi"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Mazzeo"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Dattola"
            ]
            2 => array:2 [
              "nombre" => "M&#46;V&#46;"
              "apellidos" => "Cannizzaro"
            ]
            3 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Bianchi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731018300905"
        "doi" => "10.1016/j.ad.2018.02.010"
        "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/S0001731018300905?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019300071?idApp=UINPBA000044"
    "url" => "/15782190/0000011000000002/v1_201903030657/S1578219019300071/v1_201903030657/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219018304451"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2018.12.007"
    "estado" => "S300"
    "fechaPublicacion" => "2019-03-01"
    "aid" => "1966"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2019;110:164-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1
      "HTML" => 1
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Tuberous Sclerosis Complex Associated with Hemihypertrophy and Combined Vascular Malformations"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "164"
          "paginaFinal" => "167"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Complejo de esclerosis tuberosa asociado a hemihipertrofia y malformaciones vasculares combinadas"
        ]
      ]
      "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" => 1606
              "Ancho" => 2336
              "Tamanyo" => 253375
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Limb asymmetry with overgrowth of the left arm&#46; B and C&#44; Capillary and venous vascular malformations on the anterior and posterior aspects of the arm&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;&#193;&#46; Flores-Terry, A&#46; Alegre-S&#225;nchez, P&#46; Boixeda, J&#46;C&#46; L&#243;pez-Guti&#233;rrez"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "Flores-Terry"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Alegre-S&#225;nchez"
            ]
            2 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Boixeda"
            ]
            3 => array:2 [
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "L&#243;pez-Guti&#233;rrez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731018302047"
        "doi" => "10.1016/j.ad.2017.12.010"
        "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/S0001731018302047?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018304451?idApp=UINPBA000044"
    "url" => "/15782190/0000011000000002/v1_201903030657/S1578219018304451/v1_201903030657/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
    "titulo" => "Cutaneous Langerhans Cell Histiocytosis Presenting in Adulthood"
    "tieneTextoCompleto" => true
    "saludo" => "To the Editor&#58;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "167"
        "paginaFinal" => "169"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46;A&#46; Flores-Terry, J&#46;L&#46; Sanz-Trenado, M&#46; Garc&#237;a-Arpa, M&#46;P&#46; Cortina-de la Calle"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "M&#46;A&#46;"
            "apellidos" => "Flores-Terry"
            "email" => array:1 [
              0 => "miguelterry85&#64;hotmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "J&#46;L&#46;"
            "apellidos" => "Sanz-Trenado"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Garc&#237;a-Arpa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "M&#46;P&#46;"
            "apellidos" => "Cortina-de la Calle"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital General Universitario de Ciudad Real&#44; Ciudad Real&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Anatom&#237;a Patol&#243;gica&#44; Hospital General Universitario de Ciudad Real&#44; Ciudad Real&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Histiocitosis de c&#233;lulas de Langerhans cut&#225;nea de presentaci&#243;n en el adulto"
      ]
    ]
    "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" => 1624
            "Ancho" => 2106
            "Tamanyo" => 648374
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Dense&#44; nodular-type infiltrate in the dermis&#44; with areas of necrosis&#59; hematoxylin-eosin&#44; magnification &#215;10&#41;&#46; B&#44; Histiocytes with oval or kidney-shaped nuclei resembling coffee beans and clear cytoplasm&#59; accompanied by lymphocytes and eosinophils &#40;hematoxylin-eosin&#44; magnification &#215;20&#41;&#46; C and D&#44; immunohistochemical staining was positive for S100 and CD1a&#44; respectively&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Langerhans cell histiocytosis &#40;LCH&#41; is a disease of clonal proliferation of immature Langerhans cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> LCH can affect any organ&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> occurs mainly in children&#44; and is rare in adults&#46; It is even rarer for it to be confined to the skin&#46; We present 3 cases of adult-onset cutaneous LCH treated by surgical excision&#46; No new lesions or systemic or other effects developed during follow-up&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 1&#58;</span> A 36-year-old man with no relevant medical history presented with an asymptomatic lesion that had appeared 2 months earlier&#46; It was located on the external edge of the right eyebrow&#44; and there were no associated symptoms&#46; Physical examination showed it to be a papule 6<span class="elsevierStyleHsp" style=""></span>mm in diameter that was slightly erythematous&#44; firm to the touch&#44; and well defined &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; No other skin or mucosal lesions&#44; palpable lymph nodes&#44; or enlarged organs were detected&#46; Histopathology of the excised tissue revealed a normal epidermis and a dense&#44; nodular-type infiltrate &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41; composed of dispersed cells with oval or kidney-shaped nuclei resembling coffee beans &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; The cells had a clear eosinophilic cytoplasm&#44; corresponding to histiocytes&#46; The infiltrate also contained necrotic areas&#44; lymphocytes&#44; and eosinophils&#46; The mitotic index was very low&#46; Immunohistochemical staining was positive for S100&#44; CD1a &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C and 2D&#41; and CD207 &#40;langerin&#41; and negative for CD68&#46; With these findings we made the diagnosis of LCH and ordered the following additional tests and imaging studies&#58; complete blood count&#44; coagulation screen&#44; biochemistry&#44; hormone profile&#44; urine analysis&#44; chest radiograph&#44; abdominal ultrasound&#44; and bone scans&#46; All findings were normal&#46; The final diagnosis was adult-onset LCH confined to the skin&#46; The patient has remained asymptomatic for 3 years&#46; No new skin lesions&#44; systemic symptoms&#44; or related disorders have developed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 2&#58;</span> A 33-year-old woman reported that an asymptomatic lesion had appeared on her left forearm 6 months earlier&#46; It was an erythematous&#44; infiltrated papule 5<span class="elsevierStyleHsp" style=""></span>mm in diameter &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; No enlarged lymph nodes or organs were found on physical examination&#46; The lesion was removed&#44; and the histopathologic findings&#44; similar to those described in the first case&#44; were consistent with a diagnosis of LCH&#46; The results of additional tests were negative&#44; and no new lesions or other clinical or analytic abnormalities have appeared in 2 years of follow-up&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 3&#58;</span> A 49-year-old woman presented with 2 erythematous&#44; papular lesions 5<span class="elsevierStyleHsp" style=""></span>and 7<span class="elsevierStyleHsp" style=""></span>mm in diameter located on her right cheek and back&#46; She also had a 9-mm plaque on the left side of her neck &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; No abnormalities were found on physical examination&#46; Histopathology of an excised lesion was consistent with LCH&#44; and so the remaining two were also removed&#46; The histologic findings were the same&#46; Additional studies gave no positive results&#46; No new lesions or new conditions have developed in 3 years of follow-up&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">LCH is a rare disease that is diagnosed mainly in children under the age of 15 years&#46; Over that age&#44; the estimated incidence is 5<span class="elsevierStyleHsp" style=""></span>to 9<span class="elsevierStyleHsp" style=""></span>cases per million population&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;4</span></a> The spectrum of clinical presentations ranges widely&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;6</span></a> varying according to the organ affected&#46; In some cases lesions are solitary and resolve on their own&#44; whereas in others the disease is disseminated and life-threatening&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4&#44;6&#44;10</span></a> The recent classification system of the Histiocyte Society refers specifically to a Langerhans &#40;L&#41; group of diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Diagnosis is based on clinical&#44; radiologic&#44; and histopathologic findings&#44; the last of which identifies a histiocytic infiltrate with the characteristic immunophenotypic features of LCH&#46; The disease can affect any organ but is mainly found in bones&#44; skin&#44; hypophysis&#44; liver&#44; spleen&#44; lymph glands&#44; and lungs&#59; less often&#44; the central nervous &#40;other than at the hypophysis&#41; and hematopoietic systems are involved&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The pathogenesis of LCH remains unclear&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4&#44;6&#44;7</span></a> The <span class="elsevierStyleItalic">BRAF</span> V600E mutation&#44; which overstimulates the MAPK pathway&#44; is present in half of patients with LCH&#46; Smaller proportions of patients carry the <span class="elsevierStyleItalic">MAP2K1</span> MEK1 or <span class="elsevierStyleItalic">MAP3K1</span> ARF mutations&#46; Mutations in the <span class="elsevierStyleItalic">PICK1</span> and <span class="elsevierStyleItalic">PICK3R2</span> genes&#44; affecting the PIK3CA pathway&#44; have also been described&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> These findings support the theory that LCH is a neoplastic process&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; the inflammatory component and the fact that the clinical course is sometimes benign suggest a reactive process&#46; Cases of familial LCH have been reported&#44; though no genetic predisposition has yet been identified&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Adult-onset LCH confined to the skin is very rare&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;5&#44;8</span></a> This form may present as a solitary papular or nodular lesion&#44; with or without ulceration&#44; or as multiple lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;9</span></a> It may even mimic other skin diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> In a series of 18 patients who presented with cutaneous lesions&#44; the ages ranged from 20 to 89 years and no pattern related to race or gender was identified&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Nearly half &#40;8&#47;18&#41; had solitary lesions &#40;papules or nodules&#41; or ulcerated lesions in skin folds&#46; On further study&#44; bone involvement was found in 1 of these patients and myelodysplastic syndrome was diagnosed in 2 of them&#46; During a mean follow-up period of 41 months&#44; 2 patients developed noncutaneous LCH and 5 patients were diagnosed with progressing blood tumors &#40;2 cases of myelomonocytic leukemia and 1 case each of histiocytic sarcoma&#44; diffuse large B-cell lymphoma&#44; and peripheral T-cell lymphoma&#41;&#46; The authors of that series also reviewed the literature&#44; finding 74 patients with initial presentations involving the skin&#44; 4 of whom had extended histiocytosis and 8 of whom had blood diseases found during diagnosis or follow-up&#46; The authors suggested that the association between LCH and myelomonocytic disorders could be related to the common origin of the cells in bone marrow&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> LCH is currently thought to arise in myeloid dendritic cells of the bone marrow&#44; which express the same antigens as cutaneous Langerhans cells&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The differential diagnosis of LCH includes several neoplastic and inflammatory diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Knowledge of the lesions&#8217; immunophenotype is therefore essential for a firm diagnosis&#46; Histology must demonstrate an infiltrate of Langerhans cells positive for CD1a and&#47;or CD207 &#40;langerin&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;6</span></a> a criterion that has replaced the finding of Birbeck granules by electron microscopy&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Positive staining for CD207 rules out indeterminate cell histiocytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Searching for possible extension of disease to other tissues and follow-up are essential when treating adults with skin lesions to rule out LCH in other locations and concurrent conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;6</span></a> Findings will be mainly blood disorders&#44; such as typically occur in children&#46; Tests and imaging studies recommended for adults with LCH include a complete blood count&#44; biochemistry&#44; chest radiograph&#44; hormone profile&#44; bone scans&#44; and abdominal ultrasound&#59; these studies are ordered at baseline and every 6 months during follow-up for asymptomatic patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3</span></a> A full physical examination&#44; complete blood count and biochemistry&#44; and abdominal ultrasound as well as a chest radiograph are usually ordered annually for at least 3 years&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Bone marrow should be biopsied if infiltration is suspected&#44; although some authors believe the procedure should be routine&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Because LCH in the adult is so rare&#44; optimum treatment has not been established&#46; The prognosis is good for patients with LCH confined to a single organ or system&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;6</span></a> but they should be followed closely&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;10</span></a> Local treatments &#40;surgery&#44; topical corticosteroids&#44; or corticosteroid infiltrations&#41; can be used&#46; Multiple&#44; ulcerated&#44; or resistant lesions can be treated with systemic corticosteroids&#44; phototherapy&#44; radiotherapy&#44; interferon&#44; and various chemotherapeutic regimens&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;9</span></a> It has been suggested that ulceration may affect the prognosis&#44; although to date the reported outcomes have been inconsistent&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:3 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of Interest"
        ]
        1 => array:2 [
          "identificador" => "xack395547"
          "titulo" => "Acknowledgments"
        ]
        2 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-08-01"
    "fechaAceptado" => "2017-12-26"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Flores-Terry MA&#44; Sanz-Trenado JL&#44; Garc&#237;a-Arpa M&#44; Cortina-de la Calle MP&#46; Cutaneous Langerhans Cell Histiocytosis Presenting in Adulthood&#46; Actas Dermosifiliogr&#46;2019&#59;110&#58;167&#8211;169&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 686
            "Ancho" => 2083
            "Tamanyo" => 238090
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Slightly erythematous papular lesion at the edge of the right eyebrow&#46; B&#44; Erythematous lesion on the left forearm&#46; C&#44; Slightly erythematous plaque on the left side of the neck&#46;</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" => 1624
            "Ancho" => 2106
            "Tamanyo" => 648374
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Dense&#44; nodular-type infiltrate in the dermis&#44; with areas of necrosis&#59; hematoxylin-eosin&#44; magnification &#215;10&#41;&#46; B&#44; Histiocytes with oval or kidney-shaped nuclei resembling coffee beans and clear cytoplasm&#59; accompanied by lymphocytes and eosinophils &#40;hematoxylin-eosin&#44; magnification &#215;20&#41;&#46; C and D&#44; immunohistochemical staining was positive for S100 and CD1a&#44; respectively&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Langerhans cell histiocytosis first presenting in the skin in adults&#58; Frequent association with a second haematological malignancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;R&#46; Edelbroek"
                            1 => "M&#46;H&#46; Vermeer"
                            2 => "P&#46;M&#46; Jansen"
                            3 => "T&#46;J&#46; Stoof"
                            4 => "M&#46;M&#46; van der Linden"
                            5 => "B&#46; Horv&#225;th"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2012.11169.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2012"
                        "volumen" => "167"
                        "paginaInicial" => "1287"
                        "paginaFinal" => "1294"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22835048"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Descriptive epidemiology of childhood Langerhans cell histiocytosis in France&#44; 2000-2004"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Guyot-Goubin"
                            1 => "J&#46; Donadieu"
                            2 => "M&#46; Barkaoui"
                            3 => "S&#46; Bellec"
                            4 => "C&#46; Thomas"
                            5 => "J&#46; Clavel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Blood Cancer"
                        "fecha" => "2008"
                        "volumen" => "1"
                        "paginaInicial" => "3"
                        "paginaFinal" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Management of adult patients with Langerhans cell histiocytosis&#58; Recommendations from a expert panel on behalf of Euro-Histio-Net"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Girschikofsky"
                            1 => "M&#46; Arico"
                            2 => "D&#46; Castillo"
                            3 => "A&#46; Chu"
                            4 => "C&#46; Doberauer"
                            5 => "J&#46; Fichter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Orphanet J Rare Dis&#46;"
                        "fecha" => "2013"
                        "volumen" => "14"
                        "paginaInicial" => "72"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revised classification of histiocytoses and neoplasms of the macrophage-dendritic cell lineages"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Histiocyte Society"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Emile"
                            1 => "O&#46; Abla"
                            2 => "S&#46; Fraitag"
                            3 => "A&#46; Horne"
                            4 => "J&#46; Haroche"
                            5 => "J&#46; Donadieu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/blood-2016-01-690636"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood"
                        "fecha" => "2016"
                        "volumen" => "127"
                        "paginaInicial" => "2672"
                        "paginaFinal" => "2681"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26966089"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Langerhans cell histiocytosis in adults&#58; A case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Lian"
                            1 => "Y&#46; Lu"
                            2 => "S&#46; Shen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.18632/oncotarget.7892"
                      "Revista" => array:6 [
                        "tituloSerie" => "Oncotarget"
                        "fecha" => "2016"
                        "volumen" => "7"
                        "paginaInicial" => "18678"
                        "paginaFinal" => "18683"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26942568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Self-limiting cutaneous Langerhans cells histiocytosis in an adult&#46; A case report and a review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46; Mart&#237;nez-Ortiz"
                            1 => "M&#46;D&#46; Mu&#241;oz S&#225;nchez-Reyes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Patol"
                        "fecha" => "2015"
                        "volumen" => "48"
                        "paginaInicial" => "57"
                        "paginaFinal" => "60"
                        "itemHostRev" => array:3 [
                          "pii" => "S1054139X17304056"
                          "estado" => "S300"
                          "issn" => "1054139X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathogenesis of Langerhans cell histiocytosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Badalian-Very"
                            1 => "J&#46;A&#46; Vergilio"
                            2 => "M&#46; Fleming"
                            3 => "B&#46;J&#46; Rollins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1146/annurev-pathol-020712-163959"
                      "Revista" => array:6 [
                        "tituloSerie" => "Annu Rev Pathol"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "1"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22906202"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Langerhans cell histiocytosis in adults&#46; Report from the International Registry of the Histiocyte Society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Aric&#243;"
                            1 => "M&#46; Girschikofsky"
                            2 => "T&#46; G&#233;n&#233;reau"
                            3 => "C&#46; Klersy"
                            4 => "K&#46; McClain"
                            5 => "N&#46; Grois"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cancer"
                        "fecha" => "2003"
                        "volumen" => "39"
                        "paginaInicial" => "2341"
                        "paginaFinal" => "2348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14556926"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adult Langerhans cell histiocytosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; De Menthon"
                            1 => "V&#46; Meignin"
                            2 => "A&#46; Mahr"
                            3 => "A&#46; Tazi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.lpm.2016.09.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Presse Med"
                        "fecha" => "2017"
                        "volumen" => "46"
                        "paginaInicial" => "55"
                        "paginaFinal" => "69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27816338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Erythroderma as an initial presentation of Langerhans cell histiocytosis involving the sinus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Ruiz-Villaverde"
                            1 => "M&#46; Gal&#225;n-Gutierrez"
                            2 => "F&#46; Ramos-Pleguezuelos"
                            3 => "J&#46;M&#46; Martinez de Victoria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2013.08.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2014"
                        "volumen" => "105"
                        "paginaInicial" => "630"
                        "paginaFinal" => "632"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24139467"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack395547"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">Drs Juan Luis Santiago S&#225;nchez-Mateos and Claudia Ramos-Rodr&#237;guez collaborated in preparing this report&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000011000000002/v1_201903030657/S1578219018304414/v1_201903030657/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/15782190/0000011000000002/v1_201903030657/S1578219018304414/v1_201903030657/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018304414?idApp=UINPBA000044"
]
Información del artículo
ISSN: 15782190
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 20 3 23
2024 Octubre 130 64 194
2024 Septiembre 169 46 215
2024 Agosto 189 82 271
2024 Julio 170 55 225
2024 Junio 179 67 246
2024 Mayo 139 54 193
2024 Abril 137 38 175
2024 Marzo 159 36 195
2024 Febrero 163 52 215
2024 Enero 145 49 194
2023 Diciembre 108 25 133
2023 Noviembre 226 38 264
2023 Octubre 201 36 237
2023 Septiembre 147 40 187
2023 Agosto 109 22 131
2023 Julio 130 41 171
2023 Junio 114 25 139
2023 Mayo 137 26 163
2023 Abril 81 34 115
2023 Marzo 112 20 132
2023 Febrero 136 33 169
2023 Enero 91 29 120
2022 Diciembre 98 43 141
2022 Noviembre 55 24 79
2022 Octubre 50 29 79
2022 Septiembre 53 32 85
2022 Agosto 50 31 81
2022 Julio 60 46 106
2022 Junio 30 27 57
2022 Mayo 131 55 186
2022 Abril 187 39 226
2022 Marzo 183 55 238
2022 Febrero 172 36 208
2022 Enero 140 35 175
2021 Diciembre 114 34 148
2021 Noviembre 110 48 158
2021 Octubre 117 50 167
2021 Septiembre 85 36 121
2021 Agosto 77 27 104
2021 Julio 88 18 106
2021 Junio 84 17 101
2021 Mayo 132 47 179
2021 Abril 138 69 207
2021 Marzo 93 21 114
2021 Febrero 92 29 121
2021 Enero 58 10 68
2020 Diciembre 38 19 57
2020 Noviembre 41 17 58
2020 Octubre 34 15 49
2020 Septiembre 33 12 45
2020 Agosto 17 16 33
2020 Julio 29 11 40
2020 Junio 36 17 53
2020 Mayo 19 13 32
2020 Abril 16 14 30
2020 Marzo 17 6 23
2020 Febrero 1 0 1
2019 Mayo 2 0 2
2019 Marzo 1 2 3
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Actas Dermo-Sifiliográficas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?