Case and Research Letters
Morphea «En Coup De Sabre» at the Site of Healed Herpes Zoster Ophthalmicus
Morfea en coup de sabre sobre el área cutánea de un herpes zóster oftálmico cicatrizado
a Departamento de Dermatología, ETS y Lepra, Ellahi Medicare, Kashmir, India
b Departamento de Dermatología, ETS y Lepra, Facultad de Medicina Jawaharlal Nehru (JNMC), Universidad Aligarh Muslim (AMU), Aligarh, India
c Departamento of Dermatología, Facultad de Medicina Jawaharlal Nehru (JNMC), Universidad Aligarh Muslim (AMU), Aligarh, India
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Arif, M. Adil, S. Suhail Amin, M. Alam" "autores" => array:4 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Arif" "email" => array:1 [ 0 => "dr_tasleem_arif@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Adil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Suhail Amin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Alam" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, ETS y Lepra, Ellahi Medicare, Kashmir, India" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Dermatología, ETS y Lepra, Facultad de Medicina Jawaharlal Nehru (JNMC), Universidad Aligarh Muslim (AMU), Aligarh, India" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento of Dermatología, Facultad de Medicina Jawaharlal Nehru (JNMC), Universidad Aligarh Muslim (AMU), Aligarh, India" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Morfea <span class="elsevierStyleItalic">en coup de sabre</span> sobre el área cutánea de un herpes zóster oftálmico cicatrizado" ] ] "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" => 1000 "Ancho" => 750 "Tamanyo" => 159639 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Band of thickened and indurated skin extending vertically along the forehead to the frontal scalp.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Morphea “en coup de sabre” (MCS) is a type of linear morphea that can involve the frontal and parietal region of the scalp, and the face. It mainly affects the skin and subcutaneous tissue, resulting in cicatricial alopecia.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> Morphea sites have been reported to coincide with those of other, pre-existing, inflammatory dermatoses, including herpes zoster. A thorough review of the English-language literature, however, found no report of MCS appearing at the site of healed herpes zoster ophthalmicus to date. We report what is probably the first case of MCS at the site of healed herpes zoster ophthalmicus.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 40-year-old woman visited our department with changes in the color and texture of the skin on the forehead that had begun 2 months earlier. The lesions began insidiously and advanced to the frontal scalp, giving rise to cicatricial alopecia. The patient had no history of prior trauma, abnormal vision, headaches, or convulsions. Five months earlier, the patient had visited our department with painful lesions containing fluid around the left eye and on the forehead. The lesions were diagnosed as herpes zoster; the diagnosis was confirmed by means of the Tzanck test and the lesions were treated with 500<span class="elsevierStyleHsp" style=""></span>mg of famciclovir 3 times a day for 7 days. Remission of the lesions occurred over a period of 2-4 weeks, leaving residual hyperpigmentation and scarring. In the previous 2 months, the patient observed thickening and hardening of the scalp near the forehead but no involvement of the area around the left eye.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Medical examination revealed hyperpigmentation and induration of the skin on the left side of the forehead, extending from the nasal root to the frontal scalp in a paramedian location, which led to linear cicatricial alopecia of the frontal scalp (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Other mucocutaneous, ophthalmologic, and systemic examinations revealed no findings of interest. Serology for <span class="elsevierStyleItalic">Borrelia burgdorferi</span> was negative. Radiography of the skull, including MRI, revealed no abnormalities. The biopsy revealed flattening of the dermis with atrophy of the epidermal crests, and thick hyaline collagen strands accompanied by disperse inflammatory cells and a reduced number of adnexa in the dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In light of the clinical findings and subsequent examinations MCS secondary to ophthalmic herpes zoster was diagnosed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Concomitant environmental factors such as mechanical trauma, reactions to insect bites, vaccines, radiation, drugs, infections, and even psychogenic stress have been reported in a small proportion of patient with morphea. Few case reports exist in which morphea has developed at the sites of prior herpes zoster.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–7</span></a> Grabell et al<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> reported 2 cases of morphea at the site of healed herpes zoster in a study population of 329 patients, which included both adults and children. Those authors, however, did not characterize the cases, as they did not indicate the type of morphea, the time elapsed between the 2 processes, or the sites. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the comparison of those cases with our patient (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). A thorough review of the English-language literature revealed no cases of MCS at the same site as healed ophthalmic herpes zoster, which makes our case unique.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Herpes zoster scars are the most frequent site for another disease known as Wolf isotopic response.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The causes of this phenomenon are still unknown. Local immune dysfunction and vascular changes, which would favor the consequent inflammation, have been proposed as predisposing factors.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Abnormal levels of neuropeptides in the nerves as a result of herpes infection may trigger an alteration of the immune system and facilitate the development of inflammatory dermatoses such as morphea.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,9</span></a> The sclerosis observed in morphea is attributed to the prolonged activation of the fibroblasts under the influence of Th2 cytokines such as interleukin-4 and transforming growth factor-ß, caused by varicella-zoster viruses.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Isolation of viral DNA in lesions of the second disease suggest that the herpes virus may itself be directly responsible for the clinical process.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-02" "fechaAceptado" => "2018-03-11" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Arif T. Morfea <span class="elsevierStyleItalic">en coup de sabre</span> sobre el área cutánea de un herpes zóster oftálmico cicatrizado. Actas Dermosifiliogr. 2019;110:617–619.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1000 "Ancho" => 750 "Tamanyo" => 159639 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Band of thickened and indurated skin extending vertically along the forehead to the frontal scalp.</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" => 626 "Ancho" => 900 "Tamanyo" => 163735 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Flattening of the dermis with atrophy of the epidermal crests, and densely compacted hyaline collagen strands with disperse inflammatory cells in the dermis (hematoxylin–eosin,<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">F indicates female; NA, information not provided by the authors in their article; <span class="elsevierStyleSmallCaps">M</span>, male.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case No. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case Report \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age/Sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of Morphea \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dermatome Involved \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time Elapsed Between Diseases \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qu T et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24/<span class="elsevierStyleSmallCaps">M</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bullous morphea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T9-12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 y \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Noh TW et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57/<span class="elsevierStyleSmallCaps">M</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Plaque morphea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T2-4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Forschner A et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Plaque morphea with characteristics of lichen sclerosus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C4-7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lopez N et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45/<span class="elsevierStyleSmallCaps">M</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zosteriform morphea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T2-4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 y \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ruiz Villaverde R et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zosteriform morphea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T9-10<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 y \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grabell D et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grabell D et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">This case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Morphea <span class="elsevierStyleItalic">en coup de sabre</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2114547.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Not specifically mentioned in the article but inferred from the photographs shown in the report.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Comparison of Cases of Morphea at the Site of Healed Herpes Zoster.</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" => "Morphoea and allied scarring and sclerosing inflammatory dermatoses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.H. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 14 | 25 |
| 2024 Octubre | 106 | 50 | 156 |
| 2024 Septiembre | 97 | 26 | 123 |
| 2024 Agosto | 146 | 59 | 205 |
| 2024 Julio | 105 | 35 | 140 |
| 2024 Junio | 108 | 46 | 154 |
| 2024 Mayo | 111 | 34 | 145 |
| 2024 Abril | 97 | 24 | 121 |
| 2024 Marzo | 92 | 39 | 131 |
| 2024 Febrero | 113 | 43 | 156 |
| 2024 Enero | 77 | 40 | 117 |
| 2023 Diciembre | 86 | 18 | 104 |
| 2023 Noviembre | 98 | 32 | 130 |
| 2023 Octubre | 94 | 27 | 121 |
| 2023 Septiembre | 93 | 27 | 120 |
| 2023 Agosto | 76 | 16 | 92 |
| 2023 Julio | 102 | 30 | 132 |
| 2023 Junio | 76 | 22 | 98 |
| 2023 Mayo | 81 | 18 | 99 |
| 2023 Abril | 62 | 30 | 92 |
| 2023 Marzo | 66 | 32 | 98 |
| 2023 Febrero | 71 | 21 | 92 |
| 2023 Enero | 51 | 18 | 69 |
| 2022 Diciembre | 65 | 41 | 106 |
| 2022 Noviembre | 61 | 23 | 84 |
| 2022 Octubre | 48 | 18 | 66 |
| 2022 Septiembre | 43 | 44 | 87 |
| 2022 Agosto | 51 | 31 | 82 |
| 2022 Julio | 29 | 35 | 64 |
| 2022 Junio | 32 | 22 | 54 |
| 2022 Mayo | 91 | 38 | 129 |
| 2022 Abril | 111 | 32 | 143 |
| 2022 Marzo | 108 | 51 | 159 |
| 2022 Febrero | 80 | 28 | 108 |
| 2022 Enero | 80 | 32 | 112 |
| 2021 Diciembre | 79 | 33 | 112 |
| 2021 Noviembre | 74 | 33 | 107 |
| 2021 Octubre | 107 | 44 | 151 |
| 2021 Septiembre | 75 | 41 | 116 |
| 2021 Agosto | 52 | 24 | 76 |
| 2021 Julio | 59 | 15 | 74 |
| 2021 Junio | 55 | 21 | 76 |
| 2021 Mayo | 47 | 40 | 87 |
| 2021 Abril | 118 | 63 | 181 |
| 2021 Marzo | 74 | 21 | 95 |
| 2021 Febrero | 76 | 24 | 100 |
| 2021 Enero | 41 | 6 | 47 |
| 2020 Diciembre | 56 | 20 | 76 |
| 2020 Noviembre | 44 | 13 | 57 |
| 2020 Octubre | 30 | 7 | 37 |
| 2020 Septiembre | 35 | 11 | 46 |
| 2020 Agosto | 33 | 23 | 56 |
| 2020 Julio | 24 | 15 | 39 |
| 2020 Junio | 31 | 18 | 49 |
| 2020 Mayo | 15 | 11 | 26 |
| 2020 Abril | 34 | 11 | 45 |
| 2020 Marzo | 16 | 9 | 25 |
| 2020 Febrero | 3 | 2 | 5 |
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