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Saceda Corralo, D. Ortega Quijano, R. Carrillo Gijón" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "de Perosanz Lobo" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Saceda Corralo" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Ortega Quijano" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Carrillo Gijón" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219020300822" "doi" => "10.1016/j.adengl.2018.10.029" "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/S1578219020300822?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731020300090?idApp=UINPBA000044" "url" => "/00017310/0000011100000004/v3_202009220625/S0001731020300090/v3_202009220625/es/main.assets" ] ] "itemAnterior" => array:20 [ "pii" => "S1578219020300767" "issn" => "15782190" "doi" => "10.1016/j.adengl.2020.04.004" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "2192" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2020;111:341-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Chondroid Syringoma Mimicking Basal Cell Carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "341" "paginaFinal" => "343" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Siringoma condroide simulando un carcinoma basocelular" ] ] "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" => 716 "Ancho" => 1305 "Tamanyo" => 114457 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Red nodule with a smooth surface located in the upper third of the right nasogenian sulcus. B, Dermoscopy. Reddish-white bed with irregular telangiectatic vessels and cotton-white areas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Linares González, P. Aguayo Carreras, B. Rueda Villafranca, F.J. Navarro-Triviño" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Linares González" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Aguayo Carreras" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Rueda Villafranca" ] 3 => array:2 [ "nombre" => "F.J." "apellidos" => "Navarro-Triviño" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731019301267" "doi" => "10.1016/j.ad.2018.10.023" "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/S0001731019301267?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300767?idApp=UINPBA000044" "url" => "/15782190/0000011100000004/v1_202006060751/S1578219020300767/v1_202006060751/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Interstitial Granulomatous Dermatitis and Tocilizumab: Is This Treatment Useful for This Skin Condition?" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "343" "paginaFinal" => "345" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. de Perosanz Lobo, D. Saceda Corralo, D. Ortega Quijano, R. Carrillo Gijón" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "de Perosanz Lobo" "email" => array:1 [ 0 => "dario.perosanz@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "D." "apellidos" => "Saceda Corralo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "D." "apellidos" => "Ortega Quijano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Carrillo Gijón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis granulomatosa intersticial y tocilizumab: ¿es este un tratamiento de utilidad para esta dermatosis?" ] ] "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" => 1063 "Ancho" => 800 "Tamanyo" => 137440 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous, edematous, nonscaling plaque with neat borders and annular morphology on the anterior aspect of the right arm.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Onset of interstitial granulomatous dermatitis (IGD), a rare skin disease with a variable clinical presentation and a characteristic pathological pattern, has been associated with various systemic diseases and different drugs.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Tocilizumab is a humanized monoclonal antibody directed against the interleukin-6 (IL-6) receptor, and has been used to treat IGD with good results.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> We present a case of IGD that began while the affected patient was being treated with tocilizumab, and question whether this drug is truly useful for the treatment of this disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 62-year-old woman who had a history of antisynthetase syndrome with muscle, lung, and joint involvement and had started treatment with tocilizumab at a dose of 8<span class="elsevierStyleHsp" style=""></span>mg/kg/month. She was referred to the dermatology service for slightly itchy, mildly painful skin lesions that had appeared 9 months after beginning tocilizumab treatment. The patient had no medical history of interest and had not been treated with any other drugs. The lesions consisted of well defined, infiltrated, edematous, erythematous plaques with no epidermal component that were prone to central clearing, resulting in an arciform morphology (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesions were located on the armpits, the shoulder girdle, and the internal aspects of the arms (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A skin biopsy revealed an unaltered epidermis, interstitial histiocytic infiltrate with perivascular accentuation along the entire thickness of the dermis, and an absence of mucin deposits. In certain fields, higher magnification revealed some interstitial and intravascular neutrophils (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), based on which a histopathological diagnosis of IGD was established.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was prescribed topical mometasone every 12 hours, without discontinuing tocilizumab treatment. Three months later the lesions had disappeared.</p><p id="par0025" class="elsevierStylePara elsevierViewall">IGD is a rare dermatosis, which most often appears in patients with rheumatologic diseases, especially rheumatoid arthritis,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> although it has also been associated with solid and hematological malignancies (especially myelodysplastic syndromes<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>), infections, and treatment with different drugs, including antihypertensives, anticonvulsants, antidepressants, and immunosuppressants.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Pathologically, it is characterized by interstitial lymphohistiocytic infiltrate with variable presence of neutrophils and eosinophils.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Leukocytoclastic vasculitis is occasionally observed, and collagen fiber degeneration is a constant finding.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The clinical spectrum is variable, and consists of usually asymptomatic, infiltrated, pink, erythematous or erythematous-violaceous papules or plaques, generally without an epidermal component and occasionally with annular morphology. Although infrequent, the presence of indurated linear lesions on the lateral aspects of the trunk (known as the <span class="elsevierStyleItalic">rope sign</span>) is considered almost pathognomonic.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Most cases have a good prognosis without treatment, resolving within 3 months to 3 years. Approximately 30% of cases follow a chronic course with flare-ups.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Although there are no definitive treatments for this disease, it has been successfully treated with topical and systemic corticosteroids, methotrexate, ciclosporin, and, more recently, etanercept.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Tocilizumab is a monoclonal antibody primarily used to treat rheumatoid arthritis. Several skin reactions have been associated with tocilizumab administration, including psoriasis-like reactions,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> erythema multiforme-like lesions,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> acute generalized exanthematous pustulosis,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and rheumatoid neutrophilic dermatosis.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> There are no cases of tocilizumab-induced IGD described in the literature. However, one report describes a satisfactory clinical response to tocilizumab treatment of IGD,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> suggesting a role of IL-6 in the development of granulomatous inflammation, whereby neutrophils act as the main effector cells.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In our case, it was not possible to determine whether IGD was triggered by tocilizumab treatment; the lesions resolved without discontinuing treatment and the patient had a history of rheumatological disease, which may have contributed to the onset of this dermatosis. However, the fact that the lesions developed while the patient was undergoing tocilizumab treatment casts doubt on its effectiveness as a treatment for IGD and on the role of IL-6 in the pathogenesis of this disease. As noted by Schanz and coworkers,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> the important pathogenic role of IL-6 in acute inflammation is well established; levels of this cytokine are increased in serum and synovial fluid in patients with rheumatoid arthritis and correlate with disease activity. However, the etiological and pathogenic relationship between IL-6 and IGD is unclear. Certain cases of IGD may be mediated by this cytokine, and therefore have more prominent neutrophilic infiltrate, while others may be triggered by distinct molecular pathways. Further basic and clinical research is necessary to uncover these pathways and, most importantly, to identify treatments that can most effectively shorten the natural course of the disease.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, we present a case of IGD in a patient undergoing tocilizumab treatment, and question the proposed utility of this antibody as a treatment for IGD.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de Perosanz Lobo D, Saceda Corralo D, Ortega Quijano D, Carrillo Gijón R. Dermatitis granulomatosa intersticial y tocilizumab: ¿es este un tratamiento de utilidad para esta dermatosis? Actas Dermosifiliogr. 2020;111:343–345.</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" => 1063 "Ancho" => 800 "Tamanyo" => 137440 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous, edematous, nonscaling plaque with neat borders and annular morphology on the anterior aspect of the right arm.</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" => 822 "Ancho" => 800 "Tamanyo" => 107260 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Two similar lesions with clear arciform morphology located on the posterior aspect of the right arm.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 549 "Ancho" => 1500 "Tamanyo" => 273417 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histology. A, Interstitial dermal infiltrate composed predominantly of histiocytes, with some neutrophils (hematoxylin-eosin, original magnification ×200). B, Detail of previous image. Neutrophils and lymphohistiocytic infiltrate are indicated with yellow arrows and red stars, respectively (hematoxylin-eosin, original magnification ×400).</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" => "Interstitial granulomatous dermatitis: a distinct entity with characteristic histological and clinical pattern" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Peroni" 1 => "C. Colato" 2 => "D. Schena" 3 => "P. Gisondi" 4 => "G. 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año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 6 | 6 | 12 |
2024 Octubre | 144 | 67 | 211 |
2024 Septiembre | 127 | 53 | 180 |
2024 Agosto | 135 | 88 | 223 |
2024 Julio | 120 | 69 | 189 |
2024 Junio | 119 | 80 | 199 |
2024 Mayo | 93 | 68 | 161 |
2024 Abril | 95 | 44 | 139 |
2024 Marzo | 74 | 42 | 116 |
2024 Febrero | 120 | 31 | 151 |
2024 Enero | 153 | 39 | 192 |
2023 Diciembre | 97 | 17 | 114 |
2023 Noviembre | 127 | 35 | 162 |
2023 Octubre | 114 | 31 | 145 |
2023 Septiembre | 82 | 28 | 110 |
2023 Agosto | 83 | 16 | 99 |
2023 Julio | 138 | 41 | 179 |
2023 Junio | 97 | 22 | 119 |
2023 Mayo | 153 | 25 | 178 |
2023 Abril | 101 | 16 | 117 |
2023 Marzo | 141 | 34 | 175 |
2023 Febrero | 135 | 27 | 162 |
2023 Enero | 131 | 24 | 155 |
2022 Diciembre | 95 | 31 | 126 |
2022 Noviembre | 64 | 29 | 93 |
2022 Octubre | 85 | 16 | 101 |
2022 Septiembre | 89 | 35 | 124 |
2022 Agosto | 76 | 40 | 116 |
2022 Julio | 43 | 38 | 81 |
2022 Junio | 44 | 23 | 67 |
2022 Mayo | 107 | 50 | 157 |
2022 Abril | 127 | 32 | 159 |
2022 Marzo | 92 | 48 | 140 |
2022 Febrero | 71 | 21 | 92 |
2022 Enero | 143 | 35 | 178 |
2021 Diciembre | 98 | 33 | 131 |
2021 Noviembre | 82 | 48 | 130 |
2021 Octubre | 82 | 70 | 152 |
2021 Septiembre | 73 | 65 | 138 |
2021 Agosto | 77 | 49 | 126 |
2021 Julio | 69 | 25 | 94 |
2021 Junio | 67 | 35 | 102 |
2021 Mayo | 79 | 42 | 121 |
2021 Abril | 158 | 67 | 225 |
2021 Marzo | 98 | 23 | 121 |
2021 Febrero | 57 | 26 | 83 |
2021 Enero | 58 | 12 | 70 |
2020 Diciembre | 51 | 16 | 67 |
2020 Noviembre | 48 | 13 | 61 |
2020 Octubre | 53 | 12 | 65 |
2020 Septiembre | 49 | 20 | 69 |
2020 Agosto | 39 | 17 | 56 |
2020 Julio | 54 | 16 | 70 |
2020 Junio | 70 | 37 | 107 |
2020 Mayo | 16 | 18 | 34 |
2020 Abril | 5 | 0 | 5 |