Case and Research Letters
Chronic Fibrosing Vasculitis: A Histologic Finding in a Case of Long-Established Erythema Elevatum Diutinum
Vasculitis fibrosante crónica, manifestación histológica de un eritema elevatum diutinum de larga evolución
A. García-Vázquez
, S. Guillen-Climent, F. Rausell Félix, M.D. Ramón Quiles
Autor para correspondencia
Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, Spain
Leído
4189
Vecesse ha leído el artículo
1537
Total PDF
2652
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219021001153" "issn" => "15782190" "doi" => "10.1016/j.adengl.2021.03.002" "estado" => "S300" "fechaPublicacion" => "2021-06-01" "aid" => "2556" "copyright" => "AEDV" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2021;112:556-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:20 [ "pii" => "S1578219021001438" "issn" => "15782190" "doi" => "10.1016/j.adengl.2021.03.007" "estado" => "S300" "fechaPublicacion" => "2021-06-01" "aid" => "2539" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2021;112:558-9" "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" => "Antia-Buch Flap for a Large Upper-Pole Defect of the Ear" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "558" "paginaFinal" => "559" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colgajo de Antia-Buch para un defecto amplio del polo superior de la oreja" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 618 "Ancho" => 905 "Tamanyo" => 113797 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Surgical defect after resection (a). Positioning and suture of the flaps (b).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.C. Barrera Gamboa, Á.E. Acosta Madiedo de Hart" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J.C." "apellidos" => "Barrera Gamboa" ] 1 => array:2 [ "nombre" => "Á.E." "apellidos" => "Acosta Madiedo de Hart" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731020305044" "doi" => "10.1016/j.ad.2019.10.010" "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/S0001731020305044?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001438?idApp=UINPBA000044" "url" => "/15782190/0000011200000006/v1_202106020933/S1578219021001438/v1_202106020933/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S1578219021001530" "issn" => "15782190" "doi" => "10.1016/j.adengl.2021.03.016" "estado" => "S300" "fechaPublicacion" => "2021-06-01" "aid" => "2580" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2021;112:553-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident’s Forum</span>" "titulo" => "RF- Immunotherapy in Merkel Cell Carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "553" "paginaFinal" => "555" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR -Inmunoterapia en el carcinoma de células de Merkel" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.F. García-Gil, M. Ramírez-Lluch, M.A. Concellón-Doñate" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.F." "apellidos" => "García-Gil" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Ramírez-Lluch" ] 2 => array:2 [ "nombre" => "M.A." "apellidos" => "Concellón-Doñate" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731020305536" "doi" => "10.1016/j.ad.2019.07.020" "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/S0001731020305536?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001530?idApp=UINPBA000044" "url" => "/15782190/0000011200000006/v1_202106020933/S1578219021001530/v1_202106020933/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Chronic Fibrosing Vasculitis: A Histologic Finding in a Case of Long-Established Erythema Elevatum Diutinum" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "556" "paginaFinal" => "557" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. García-Vázquez, S. Guillen-Climent, F. Rausell Félix, M.D. Ramón Quiles" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "García-Vázquez" "email" => array:1 [ 0 => "alejandrogv92@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Guillen-Climent" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Rausell Félix" ] 3 => array:2 [ "nombre" => "M.D." "apellidos" => "Ramón Quiles" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vasculitis fibrosante crónica, manifestación histológica de un eritema elevatum diutinum de larga evolución" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 524 "Ancho" => 1674 "Tamanyo" => 459122 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fibrosis and an increase in dermal collagen, which is arranged concentrically around the blood vessels and in parallel bundles. Hematoxylin-eosin, original magnification × 100 (A) and × 200 (B).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 38-year-old man who was seen for 2 asymptomatic brownish plaques on the left popliteal fossa. He had received no previous treatment for the plaques, which had been present since childhood. On the surface of each of the 2 plaques were excrescent fibrous papules of the same color as the plaques (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Biopsy of one of the plaques 6 years earlier had shown histological findings consistent with erythema elevatum diutinum (EED). A new biopsy showed perivascular lymphohistiocytic inflammatory infiltrate and an increase in dermal collagen, which was arranged in concentric bands parallel to the epidermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The clinical and histological findings were compatible with a diagnosis of localized chronic fibrosing vasculitis. The results of laboratory tests, including autoimmunity studies and blood tests, a chest X-ray, and an abdominal ultrasound were all normal. Given the stability of the lesions and the absence of clinical signs, a wait-and-see approach was adopted and periodic follow-up was scheduled.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In 1997, Carlson and LeBoit described a series of 8 patients who had solitary lesions with histological hallmarks suggestive of the late stages of EED and facial granuloma (FG), but incompatible clinical signs.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They called this condition localized chronic fibrosing vasculitis. Since then, there have been multiple descriptions of patients with lesions histologically compatible with EED and FG, but clinical signs that do not fit with the classic presentation. EED and FG are 2 entities classified within the group of chronic fibrosing vasculitis, and share some common clinical and pathological characteristics. EED traditionally presents as erythematous–violaceous papules, plaques, or nodules distributed bilaterally or symmetrically on the extensor surfaces of the extremities (especially the interphalangeal joints, elbows, knees, and ankles),<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> while classic FG presents as one or more brown erythematous papules or plaques located on the face,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> although extrafacial involvement has been described, as well as cases without facial lesions.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> These 2 conditions share similar histological findings: the acute phase is characterized by leukocytoclastic vasculitis with numerous neutrophils, and the chronic phase by cicatricial changes and fibrosis with a concentric or storiform perivascular distribution.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Histological data that guide the diagnosis include a predominantly neutrophilic infiltrate and more marked fibrosis in EED, and the presence of eosinophils and an intact subepidermal Grenz zone in FG.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,5,6</span></a> However, in many cases overlapping histological findings prevent differentiation between the 2 entities,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> and therefore diagnosis is usually based on the clinical presentation.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The literature describes many atypical cases that do not correspond to any of the classic presentations, due to either the location or distribution of the lesions. Some authors refer to these forms as atypical EED, and others as FG with extrafacial involvement. Furthermore, there are published descriptions of atypical EED with facial involvement,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and of extrafacial FG without lesions on the face.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> There are no clear criteria regarding the use of one term or the other. In most cases the choice appears to be arbitrary, which has led to some confusion.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although there are discrepancies, most authors agree that EED, FG, and their atypical presentations lie on the same spectrum and that chronic fibrosing vasculitis is a common and characteristic histological finding in advanced disease stages characterized by an increase in dermal collagen bundles, which are arranged parallel to the epidermis and concentrically around the vessels. We agree with this view, and wish to emphasize the diagnostic value of this histological pattern in atypical cases, such as that presented here, in which clinical signs alone may be insufficient to guide the diagnosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Vázquez A, Guillen-Climent S, Rausell Félix F, Ramón Quiles MD. Vasculitis fibrosante crónica, manifestación histológica de un eritema elevatum diutinum de larga evolución. Actas Dermosifiliogr. 2021;112:556–557.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 726 "Ancho" => 1674 "Tamanyo" => 170992 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Brownish plaques with superficial papules located on the left popliteal fossa. B, After biopsy the plaques acquired a more erythematous appearance, but remained stable.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 524 "Ancho" => 1674 "Tamanyo" => 459122 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fibrosis and an increase in dermal collagen, which is arranged concentrically around the blood vessels and in parallel bundles. Hematoxylin-eosin, original magnification × 100 (A) and × 200 (B).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Localized chronic fibrosing vasculitis of the skin: an inflammatory reaction that occurs in settings other than erythema elevatum diutinum and granuloma faciale" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. Carlson" 1 => "P.E. LeBoit" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000478-199706000-00010" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "1997" "volumen" => "21" "paginaInicial" => "698" "paginaFinal" => "705" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9199648" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Late-stage nodular erythema elevatum diutinum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.A. High" 1 => "M.P. Hoang" 2 => "K. Stevens" 3 => "C.J. Cockerell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/s0190-9622(03)01834-6" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2003" "volumen" => "49" "paginaInicial" => "764" "paginaFinal" => "767" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14512939" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Eritema elevatum diutinum o granuloma facial extrafacial?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Navarro" 1 => "D. de Argila" 2 => "J. Fraga" 3 => "A. García-Diez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2010.03.023" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2010" "volumen" => "101" "paginaInicial" => "814" "paginaFinal" => "815" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21034719" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma Faciale. En: StatPearls" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Al Dhafiri" 1 => "F. Kaliyadan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "http://www.ncbi.nlm.nih.gov/books/NBK539832/" "fecha" => "2019" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extrafacial granuloma faciale: a case report and brief review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Deen" 1 => "T.P. Moloney" 2 => "J. Muir" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000477960" "Revista" => array:6 [ "tituloSerie" => "Case Rep Dermatol" "fecha" => "2017" "volumen" => "9" "paginaInicial" => "79" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28868005" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic localized leukocytoclastic vasculitis: clinicopathological spectrum of granuloma faciale with and without extrafacial and mucosal involvement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Vassallo" 1 => "F. Derlino" 2 => "G.A. Croci" 3 => "V. Brazzelli" 4 => "G. Borroni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "G Ital Dermatol Venereol" "fecha" => "2015" "volumen" => "150" "paginaInicial" => "87" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25592670" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical erythema elevatum diutinum or extrafacial granuloma faciale?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Ziemer" 1 => "K. Schwede" 2 => "J.-C. Simon" 3 => "U. Paasch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ddg.12003" "Revista" => array:6 [ "tituloSerie" => "J Dtsch Dermatol Ges" "fecha" => "2013" "volumen" => "11" "paginaInicial" => "178" "paginaFinal" => "180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23253514" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma faciale: a clinicopathologic study of 66 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Ortonne" 1 => "J. Wechsler" 2 => "M. Bagot" 3 => "E. Grosshans" 4 => "B. Cribier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2005.08.021" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2005" "volumen" => "53" "paginaInicial" => "1002" "paginaFinal" => "1009" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16310061" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Violaceous nodules on the face and back of a patient with inflammatory arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Merrill" 1 => "N. Fett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0000000000000392" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2017" "volumen" => "39" "paginaInicial" => "111" "paginaFinal" => "112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28134727" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma faciale: exclusively extrafacial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.V. Surana" 1 => "G. Arghyaprasun" 2 => "B. Saugato" 3 => "N. Falguni" 4 => "C. Gobinda" 5 => "H. Chinmay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5154.110884" "Revista" => array:5 [ "tituloSerie" => "Indian J Dermatol" "fecha" => "2013" "volumen" => "58" "paginaInicial" => "245" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23723516" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011200000006/v1_202106020933/S1578219021001153/v1_202106020933/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/15782190/0000011200000006/v1_202106020933/S1578219021001153/v1_202106020933/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001153?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 3 | 3 | 6 |
| 2024 Octubre | 70 | 44 | 114 |
| 2024 Septiembre | 68 | 28 | 96 |
| 2024 Agosto | 92 | 58 | 150 |
| 2024 Julio | 70 | 26 | 96 |
| 2024 Junio | 73 | 20 | 93 |
| 2024 Mayo | 68 | 33 | 101 |
| 2024 Abril | 67 | 23 | 90 |
| 2024 Marzo | 78 | 37 | 115 |
| 2024 Febrero | 88 | 35 | 123 |
| 2024 Enero | 47 | 27 | 74 |
| 2023 Diciembre | 40 | 21 | 61 |
| 2023 Noviembre | 70 | 23 | 93 |
| 2023 Octubre | 73 | 29 | 102 |
| 2023 Septiembre | 70 | 29 | 99 |
| 2023 Agosto | 48 | 16 | 64 |
| 2023 Julio | 66 | 31 | 97 |
| 2023 Junio | 60 | 20 | 80 |
| 2023 Mayo | 65 | 28 | 93 |
| 2023 Abril | 44 | 18 | 62 |
| 2023 Marzo | 50 | 46 | 96 |
| 2023 Febrero | 60 | 21 | 81 |
| 2023 Enero | 54 | 22 | 76 |
| 2022 Diciembre | 49 | 30 | 79 |
| 2022 Noviembre | 37 | 23 | 60 |
| 2022 Octubre | 33 | 13 | 46 |
| 2022 Septiembre | 32 | 44 | 76 |
| 2022 Agosto | 30 | 22 | 52 |
| 2022 Julio | 31 | 38 | 69 |
| 2022 Junio | 28 | 32 | 60 |
| 2022 Mayo | 47 | 40 | 87 |
| 2022 Abril | 65 | 42 | 107 |
| 2022 Marzo | 67 | 68 | 135 |
| 2022 Febrero | 58 | 33 | 91 |
| 2022 Enero | 75 | 37 | 112 |
| 2021 Diciembre | 45 | 35 | 80 |
| 2021 Noviembre | 62 | 50 | 112 |
| 2021 Octubre | 54 | 56 | 110 |
| 2021 Septiembre | 41 | 43 | 84 |
| 2021 Agosto | 45 | 35 | 80 |
| 2021 Julio | 52 | 20 | 72 |
| 2021 Junio | 62 | 41 | 103 |
| 2021 Mayo | 55 | 39 | 94 |
| 2021 Abril | 106 | 68 | 174 |
| 2021 Marzo | 154 | 90 | 244 |
Mostrar todo
